{ "hospital_name": "Monroe Hospital", "last_updated_on": "2026-03-17", "version": "3.0", "location_name": [ "Monroe Hospital" ], "hospital_address": [ "4011 South Monroe Medical Park Boulevard Bloomington, IN 47403" ], "license_information": { "license_number": "472105584", "state": "IN" }, "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": "Luis Leon" }, "type_2_npi": [ "1740686443" ], "standard_charge_information": [ { "description": "**LCK SCRW 2.4X18MM TAP**USE 90003532", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 3430.7, "10th_percentile": 777, "90th_percentile": 3658.2, "count": "1 through 10" } ] } ] }, { "description": "***DO NOT USE***", "code_information": [ { "code": "78445", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 997, "discounted_cash": 420, "minimum": 299.1, "maximum": 997, "payers_information": [ { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 732.35, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 589.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 824.94, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 568.2, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 409.62 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 429.31, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 816.53, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Pathfinder Advisor", "plan_name": "Path Finder Advisor Commercial (OP Only) (05-01-2021 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 565.68 }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 816.53, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 841.78, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 462.98, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 833.36, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 816.53, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 409.62 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 420.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 420.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 420.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 409.62 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 420.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 420.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 841.78, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 420.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 799.69, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 420.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 816.53, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 420.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 409.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 420.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 757.6, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 610.29, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 409.62 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 409.62 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 420.89, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "* STATUS URINE PREGNANCY TEST", "code_information": [ { "code": "84703", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 50, "discounted_cash": 7, "minimum": 3.9, "maximum": 198.92, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 75, "median_amount": 7.52, "10th_percentile": 7.52, "90th_percentile": 7.52, "count": "1 through 10" }, { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 7.52 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 7.52 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 10.9, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 7.52 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 7.52 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.08, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.53, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.74, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.15, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.52 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.67, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.04, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.27, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.89, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.52 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 22, "10th_percentile": 22, "90th_percentile": 22, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 7.52 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.04, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "**TEST CELL COUNT CSF", "code_information": [ { "code": "89050", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 160.79, "discounted_cash": 4, "minimum": 4.72, "maximum": 160.79, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.16, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 4.72 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 4.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 4.72 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.5, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 6.84, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 4.72 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 4.72 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.25, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.37, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.72 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.16, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.16, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.19, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.35, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.16, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.72 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 4.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 4.72 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.97, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "*NFLOrazePAM 2MG CPJ(ATIVAN) 1ML", "drug_information": { "unit": 2, "type": "ME" }, "code_information": [ { "code": "409198530", "type": "NDC" }, { "code": "J2060", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 2.31, "10th_percentile": 2.3, "90th_percentile": 2.31, "count": "12" } ] } ] }, { "description": "**TEST CELL COUNT BODY FLUID", "code_information": [ { "code": "89051", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 160.79, "discounted_cash": 5, "minimum": 5.6, "maximum": 340, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.86, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 5.6 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 5.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 5.6 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.08, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 8.12, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 5.6 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 5.6 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.74, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.84, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.98, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.56, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.6 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.71, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.86, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.86, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.16, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.09, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.86, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.6 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 5.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.64, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "* TRIAGE TROPONIN I", "code_information": [ { "code": "84484", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 90, "discounted_cash": 12, "minimum": 12.47, "maximum": 90, "payers_information": [ { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.19, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance Off Exchange Pathway", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 24.94, "10th_percentile": 24.94, "90th_percentile": 24.94, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 12.47, "10th_percentile": 12.47, "90th_percentile": 12.47, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 12.47 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 12.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 12.47 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.45, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 18.08, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 12.47 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 12.47 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.44, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.83, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.47 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.19, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.19, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.72, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.69, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.19, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.47 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 12.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 39.6, "10th_percentile": 39.6, "90th_percentile": 39.6, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 12.47 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.69, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "*NFDILTIAZEM (CARDIZEM) VIAL:50mg10mL", "drug_information": { "unit": 50, "type": "ME" }, "code_information": [ { "code": "409117102", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 4.73, "10th_percentile": 4.73, "90th_percentile": 4.73, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 5.16, "10th_percentile": 5.16, "90th_percentile": 5.16, "count": "1 through 10" } ] } ] }, { "description": "*POC BMP WITH IONIZED CALCIUM", "code_information": [ { "code": "80047", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 262, "discounted_cash": 13, "minimum": 13.73, "maximum": 262, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.64, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 13.73 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 13.73 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.71, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 19.91, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 13.73 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 13.73 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.89, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.91, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.73 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.64, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.64, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.46, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.1, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.19, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.64, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.73 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 13.73 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.46, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.09, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "*LIPASE", "code_information": [ { "code": "83690", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 162, "discounted_cash": 6, "minimum": 6.89, "maximum": 162, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 75, "median_amount": 121.5, "10th_percentile": 121.5, "90th_percentile": 121.5, "count": "1 through 10" }, { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.37, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 113.4, "10th_percentile": 6.89, "90th_percentile": 113.4, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 6.89 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 6.89 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.4, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 9.99, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 6.89 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 6.89 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.99, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.5, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.89 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.03, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.37, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.37, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.78, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.58, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.64, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.37, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.89 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 71.28, "10th_percentile": 71.28, "90th_percentile": 71.28, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 6.89 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.78, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.09, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "*POC BUNCREA", "code_information": [ { "code": "84520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 85, "discounted_cash": 3, "minimum": 2.1, "maximum": 85, "payers_information": [ { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.66, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 59.5, "10th_percentile": 49.98, "90th_percentile": 59.5, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 3.95 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 3.95 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.11, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 5.73, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 3.95 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 3.95 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.53, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.74, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.33, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.95 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.03, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.66, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.66, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.66, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.95 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 37.4, "10th_percentile": 37.4, "90th_percentile": 37.4, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 3.95 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.51, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "*POC POTASSIUM", "code_information": [ { "code": "84132", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 80, "discounted_cash": 4, "minimum": 2.4, "maximum": 80, "payers_information": [ { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.23, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 4.76 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 4.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 4.76 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.57, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 6.9, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 4.76 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 4.76 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.28, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.66, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.33, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.43, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.76 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.23, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.23, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.52, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.24, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.42, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.23, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.76 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 4.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 4.76 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.52, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.04, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "*NF XENADERM OINTMENT 30 GM", "drug_information": { "unit": 1, "type": "UN" }, "code_information": [ { "code": "58980079011", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 5.16, "10th_percentile": 5.16, "90th_percentile": 5.16, "count": "1 through 10" } ] } ] }, { "description": "*POC CALCIUM IONIZED", "code_information": [ { "code": "82330", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 35, "discounted_cash": 13, "minimum": 10.5, "maximum": 35, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 13.68 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.62, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 19.84, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 13.68 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 13.68 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.8, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.81, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.47, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.68 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.95, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.54, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.54, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.09, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.54, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.68 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 13.68 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.99, "additional_payer_notes": "190.00% of Medicare Rates" }, { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.54, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 13.68 } ] } ] }, { "description": "*POC BUN", "code_information": [ { "code": "84520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 85, "discounted_cash": 3, "minimum": 2.1, "maximum": 85, "payers_information": [ { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.66, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 59.5, "10th_percentile": 49.98, "90th_percentile": 59.5, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 3.95 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 3.95 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.11, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 5.73, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 3.95 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 3.95 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.53, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.74, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.33, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.95 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.03, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.66, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.66, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.66, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.95 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 37.4, "10th_percentile": 37.4, "90th_percentile": 37.4, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 3.95 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.51, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "*RL ALLERGEN PROFILE 6 FOOD BASIC", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 97.8, "discounted_cash": 5, "minimum": 2.1, "maximum": 293.4, "payers_information": [ { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.13, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.4, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 7.57, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.08, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.23, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.13, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.13, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.34, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.13, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 11.88, "10th_percentile": 9.75, "90th_percentile": 43.03, "count": "13" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.92, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "*POC CHLORIDE", "code_information": [ { "code": "82435", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6, "discounted_cash": 4, "minimum": 1.8, "maximum": 6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 4.6 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 4.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 4.6 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 6, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 4.6 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 4.6 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.6 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.69, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.6 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 4.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 4.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "*POC CREATININE", "code_information": [ { "code": "82565", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40, "discounted_cash": 5, "minimum": 5.12, "maximum": 40, "payers_information": [ { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.93, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 28, "10th_percentile": 23.52, "90th_percentile": 28, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 5.12 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 5.12 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 7.42, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 5.12 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 5.12 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.91, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.04, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.91, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.12 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.93, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.93, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.24, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.63, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.14, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.93, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.12 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 17.6, "10th_percentile": 17.6, "90th_percentile": 17.6, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 5.12 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.24, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.73, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "*POC GLUCOSE", "code_information": [ { "code": "82947", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 80.1, "discounted_cash": 3, "minimum": 2.1, "maximum": 80.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.62, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 3.93 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 3.93 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.07, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 5.7, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 3.93 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 3.93 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.84, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.7, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.31, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.93 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.01, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.62, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.62, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.32, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.62, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.93 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 3.93 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.47, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "*RL ALLERGEN PROFILE - FOOD - BASIC", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 97.8, "discounted_cash": 5, "minimum": 2.1, "maximum": 293.4, "payers_information": [ { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.13, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.4, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 7.57, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.08, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.23, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.13, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.13, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.34, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.13, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 11.88, "10th_percentile": 9.75, "90th_percentile": 43.03, "count": "13" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.92, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "*POC TCO2", "code_information": [ { "code": "82374", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 34, "discounted_cash": 4, "minimum": 1.8, "maximum": 34, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.47, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 4.88 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 4.88 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.78, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 7.08, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 4.88 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 4.88 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.49, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.56, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.59, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.88 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.98, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.47, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.47, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.76, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.37, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.47, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.88 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 4.88 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.76, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.27, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "*POC LACTIC ACID", "code_information": [ { "code": "83605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 100, "discounted_cash": 11, "minimum": 11.57, "maximum": 100, "payers_information": [ { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.45, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 70, "10th_percentile": 70, "90th_percentile": 70, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 11.57 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 11.57 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.83, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 16.78, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 11.57 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 11.57 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.13, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.68, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.62, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.57 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.8, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.45, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.45, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.73, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.91, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.45, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.57 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 44, "10th_percentile": 44, "90th_percentile": 44, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 11.57 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.98, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "*RL ACETYLCHOLINE RECEPTOR BLOCKING AB", "code_information": [ { "code": "83519", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 150, "discounted_cash": 18, "minimum": 4.5, "maximum": 1200, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.12, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 26.68, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 18.4 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 18.4 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.02, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.06, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.84, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.4 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.77, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.7, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.7, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.43, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.7, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.4 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 18.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.96, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.7, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 18.4, "10th_percentile": 18.4, "90th_percentile": 18.4, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 18.4 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 18.4 } ] } ] }, { "description": "*RL BLASTOMYCES ANTIBODIES QUANTITATIVE", "code_information": [ { "code": "86612", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 61.1, "discounted_cash": 12, "minimum": 12.9, "maximum": 577.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.03, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 12.9 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 12.9 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.22, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 18.71, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 12.9 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 12.9 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.45, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.28, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.42, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.9 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.16, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.03, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.03, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.19, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.54, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.03, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.9 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 12.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.51, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "*RL ACETYLCHOLINE RECEPTOR BINDING AB", "code_information": [ { "code": "83519", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 57, "discounted_cash": 18, "minimum": 4.5, "maximum": 1200, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.7, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 18.4, "10th_percentile": 18.4, "90th_percentile": 18.4, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 18.4 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 18.4 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.12, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 26.68, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 18.4 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 18.4 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.02, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.06, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.84, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.4 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.77, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.7, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.7, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.43, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.7, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.4 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 18.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.96, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "*POC SODIUM", "code_information": [ { "code": "84295", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 84, "discounted_cash": 4, "minimum": 2.4, "maximum": 84, "payers_information": [ { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.33, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 4.81 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 4.81 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.66, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 6.97, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 4.81 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 4.81 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.37, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.73, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.43, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.49, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.81 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.91, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.33, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.33, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.29, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.52, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.33, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.81 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 4.81 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.14, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "*RL ACETYLCHOLINE RECEPTOR MODULATING A", "code_information": [ { "code": "83519", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 195.48, "discounted_cash": 18, "minimum": 4.5, "maximum": 1200, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 18.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.96, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.7, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 18.4, "10th_percentile": 18.4, "90th_percentile": 18.4, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 18.4 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 18.4 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.12, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 26.68, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 18.4 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 18.4 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.02, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.06, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.84, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.4 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.77, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.7, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.7, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.43, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.7, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.4 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "*RL BORDETELLA PERTUSSIS AB, IGA QUANT", "code_information": [ { "code": "86615", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 82.45, "discounted_cash": 13, "minimum": 13.19, "maximum": 242.14, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.59, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 13.19 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 13.19 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.74, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 19.13, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 13.19 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 13.19 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.95, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.47, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.85, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.81, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.19 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.45, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.59, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.59, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.38, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.51, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.12, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.59, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.19 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 13.19 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.38, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.06, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "*RL BK QUANTITATION URINE PCR", "code_information": [ { "code": "87799", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 705, "discounted_cash": 42, "minimum": 39.408, "maximum": 705, "payers_information": [ { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 83.11, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 42.84 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 42.84 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 77.11, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 62.12, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 42.84 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 42.84 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 74.54, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 59.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 83.97, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 57.83, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42.84 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.7, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 83.11, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 83.11, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 85.68, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.12, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 84.82, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 83.11, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42.84 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 42.84 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 85.68, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 81.4, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "*RL 17-HYDROXYPREGNENOLONE", "code_information": [ { "code": "84143", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 166.95, "discounted_cash": 22, "minimum": 22.81, "maximum": 166.95, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 44.25, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 22.81 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 22.81 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 41.06, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 33.07, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 22.81 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 22.81 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 39.69, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 44.71, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.79, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.81 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.27, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 44.25, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 44.25, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 45.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.09, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 45.16, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 44.25, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.81 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 22.81 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 45.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.34, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "*RL BORDETELLA PERTUSSIS AB, IGG QUANT", "code_information": [ { "code": "86615", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 242.14, "discounted_cash": 13, "minimum": 13.19, "maximum": 242.14, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.59, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 13.19 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 13.19 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.74, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 19.13, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 13.19 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 13.19 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.95, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.47, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.85, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.81, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.19 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.45, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.59, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.59, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.38, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.51, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.12, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.59, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.19 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 13.19 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.38, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.06, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "*RL CARDIOLIPIN AB IGM", "code_information": [ { "code": "86147", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 28.2, "discounted_cash": 25, "minimum": 8.46, "maximum": 28.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.2, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 39.48, "10th_percentile": 39.48, "90th_percentile": 50.9, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 25.45 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 25.45 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.2, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 28.2, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 25.45 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 25.45 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.2, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.2, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.2, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.45 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.96, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.2, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.2, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.2, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.2, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.45 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 12.41, "10th_percentile": 12.41, "90th_percentile": 12.41, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 25.45 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.2, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "*RL BK QUANTITATIVE PCR (PLASMA)", "code_information": [ { "code": "87799", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 465, "discounted_cash": 42, "minimum": 39.408, "maximum": 705, "payers_information": [ { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 83.11, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 42.84 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 42.84 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 77.11, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 62.12, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 42.84 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 42.84 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 74.54, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 59.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 83.97, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 57.83, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42.84 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.7, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 83.11, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 83.11, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 85.68, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.12, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 84.82, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 83.11, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42.84 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 42.84 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 85.68, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 81.4, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "*RL ALPHA 1 ANTI-TRYPSIN QNT", "code_information": [ { "code": "82103", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 45, "discounted_cash": 13, "minimum": 13.44, "maximum": 45, "payers_information": [ { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 31.5, "10th_percentile": 31.5, "90th_percentile": 31.5, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 13.44 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 13.44 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.19, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 19.49, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 13.44 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 13.44 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.39, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.34, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.14, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.44 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.71, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.61, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.44 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 19.8, "10th_percentile": 19.8, "90th_percentile": 19.8, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 13.44 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.54, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "*RL ETHYL GLUCURONIDE", "code_information": [ { "code": "80307", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 175, "discounted_cash": 62, "minimum": 4.5, "maximum": 280.95, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 75, "median_amount": 93, "10th_percentile": 93, "90th_percentile": 93, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 120.55, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 62.14, "10th_percentile": 31.7, "90th_percentile": 62.14, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 62.14 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 62.14 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 111.85, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 90.1, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 62.14 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 62.14 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 108.12, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 121.79, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 83.89, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 62.14 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 63.38, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 120.55, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 120.55, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 124.28, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 68.35, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 123.04, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 120.55, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 62.14 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 71.12, "10th_percentile": 71.12, "90th_percentile": 71.12, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 62.14 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 124.28, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 118.07, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "*RL CYSTIC FIBROSIS PROFILE - DNAGENOT", "code_information": [ { "code": "81220", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 171.06, "discounted_cash": 556, "minimum": 51.318, "maximum": 171.06, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 171.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 171.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 171.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 171.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 171.06, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 171.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 171.06, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 171.06 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 171.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 171.06 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 171.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 171.06, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 171.06, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 171.06 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 171.06 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 171.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 171.06, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 171.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 171.06, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 171.06, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 171.06 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 171.06, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 171.06, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 171.06, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 171.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 171.06, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 171.06, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 171.06, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 171.06 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 171.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 171.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 171.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 171.06 } ] } ] }, { "description": "*RL CALPROTECTIN, FECAL", "code_information": [ { "code": "83993", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 300, "discounted_cash": 19, "minimum": 19.63, "maximum": 300, "payers_information": [ { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 38.08, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 19.63 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 19.63 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.33, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 28.46, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 19.63 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 19.63 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.16, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 38.47, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.5, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.63 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.02, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 38.08, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 38.08, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 39.26, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.59, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 38.87, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 38.08, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.63 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 19.63 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 39.26, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 37.3, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "*RL ANTISCLERODERMA - 70 ANTIBODIES", "code_information": [ { "code": "86235", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 80, "discounted_cash": 17, "minimum": 7.5, "maximum": 182.5, "payers_information": [ { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.78, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 62.93, "10th_percentile": 51.31, "90th_percentile": 127.75, "count": "14" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 17.93 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 17.93 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.27, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 17.93 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 17.93 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.2, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.14, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.21, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.93 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.29, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.78, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.78, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.72, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.5, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.78, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.93 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 35.2, "10th_percentile": 11, "90th_percentile": 80.3, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 17.93 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.07, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "*RL FACTOR VII ANTIGEN *RESEARCH*", "code_information": [ { "code": "85230", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 203.65, "discounted_cash": 17, "minimum": 17.9, "maximum": 203.65, "payers_information": [ { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.73, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 142.56, "10th_percentile": 142.56, "90th_percentile": 142.56, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 17.9 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 17.9 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.22, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 25.96, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 17.9 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 17.9 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.15, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.08, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.17, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.9 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.26, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.73, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.73, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.69, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.44, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.73, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.9 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 17.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.01, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "*RL DES-GAMMA CARBOXY PROTHROMBIN", "code_information": [ { "code": "83951", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 420.27, "discounted_cash": 64, "minimum": 37.5, "maximum": 420.27, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 124.96, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 64.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 64.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 115.94, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 93.39, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 64.41 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 64.41 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 112.07, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 90.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 126.24, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 86.95, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 64.41 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65.7, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 124.96, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 124.96, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 128.82, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 70.85, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 127.53, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 124.96, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 64.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 64.41 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 128.82, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 122.38, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "*RL COBALT PLASMA", "code_information": [ { "code": "83018", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 109.95, "discounted_cash": 21, "minimum": 21.96, "maximum": 190, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 42.6, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 21.96 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 21.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 21.96 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 39.53, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 31.84, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 21.96 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 21.96 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 38.21, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.04, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.65, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.96 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.4, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 42.6, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 42.6, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.16, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.48, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 42.6, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.96 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 21.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 21.96 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 41.72, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "*RL BORDETELLA PERTUSSIS REAL-DNA PCR", "code_information": [ { "code": "87798", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 243, "discounted_cash": 35, "minimum": 18.3, "maximum": 1653.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 68.07, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 63.16, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 50.88, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 61.06, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 68.78, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 47.37, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.79, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 68.07, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 68.07, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 70.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 69.48, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 68.07, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 47.2, "10th_percentile": 47.2, "90th_percentile": 47.2, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 70.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 66.67, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "*RL FREE T4 BY DIALYSISMASS SPEC", "code_information": [ { "code": "84439", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 130.3, "discounted_cash": 9, "minimum": 6.6, "maximum": 172, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 75, "median_amount": 129, "10th_percentile": 129, "90th_percentile": 129, "count": "1 through 10" }, { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.5, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 4.27, "10th_percentile": 4.27, "90th_percentile": 9.02, "count": "12" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 9.02 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 9.02 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.24, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 13.08, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 9.02 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 9.02 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.69, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.68, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.18, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.02 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.2, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.5, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.5, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.04, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.92, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.86, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.5, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.02 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 75.68, "10th_percentile": 75.68, "90th_percentile": 75.68, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 9.02 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.04, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.14, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "*RL DRUG PANEL(10 DRUGS + OXY, AL)*", "code_information": [ { "code": "80307", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 161.64, "discounted_cash": 62, "minimum": 4.5, "maximum": 280.95, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 75, "median_amount": 121.23, "10th_percentile": 121.23, "90th_percentile": 135, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 120.55, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 62.14, "10th_percentile": 31.7, "90th_percentile": 62.14, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 62.14 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 62.14 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 111.85, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 90.1, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 62.14 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 62.14 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 108.12, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 121.79, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 83.89, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 62.14 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 63.38, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 120.55, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 120.55, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 124.28, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 68.35, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 123.04, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 120.55, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 62.14 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 71.12, "10th_percentile": 71.12, "90th_percentile": 71.12, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 62.14 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 124.28, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 118.07, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "*RL DRUG SCREEN", "code_information": [ { "code": "80307", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40, "discounted_cash": 62, "minimum": 4.5, "maximum": 280.95, "payers_information": [ { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 40, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 40, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 40, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 71.12, "10th_percentile": 71.12, "90th_percentile": 71.12, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 40 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 40, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 40, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 75, "median_amount": 121.23, "10th_percentile": 121.23, "90th_percentile": 135, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 40, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 62.14, "10th_percentile": 31.7, "90th_percentile": 62.14, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 40 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 40, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 40 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 40, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 40, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 40 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 40 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 40, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 40, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 40, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 40, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 40, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 40, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 40, "additional_payer_notes": "198.00% of Medicare Rates" } ] } ] }, { "description": "*RL BORDETELLA PERTUSSIS AB, IGM QUANT", "code_information": [ { "code": "86615", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 74.95, "discounted_cash": 13, "minimum": 13.19, "maximum": 242.14, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.59, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 13.19 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 13.19 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.74, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 19.13, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 13.19 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 13.19 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.95, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.47, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.85, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.81, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.19 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.45, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.59, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.59, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.38, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.51, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.12, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.59, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.19 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 13.19 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.38, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.06, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "*RL GLIADIN ANTIBODY PROFILE IGG,IGA EI", "code_information": [ { "code": "83516", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 73.4, "discounted_cash": 11, "minimum": 4.5, "maximum": 337.2, "payers_information": [ { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.37, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 11.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 11.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.75, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 11.53 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 11.53 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.06, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.6, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.57, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.53 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.76, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.37, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.37, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.83, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.37, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.53 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 6.6, "10th_percentile": 6.6, "90th_percentile": 44.88, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 11.53 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.91, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "*RL DRUG PANEL(12 DRUGS)*", "code_information": [ { "code": "80307", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 270, "discounted_cash": 62, "minimum": 4.5, "maximum": 280.95, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 75, "median_amount": 121.23, "10th_percentile": 121.23, "90th_percentile": 135, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 120.55, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 62.14, "10th_percentile": 31.7, "90th_percentile": 62.14, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 62.14 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 62.14 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 111.85, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 90.1, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 62.14 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 62.14 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 108.12, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 121.79, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 83.89, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 62.14 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 63.38, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 120.55, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 120.55, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 124.28, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 68.35, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 123.04, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 120.55, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 62.14 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 71.12, "10th_percentile": 71.12, "90th_percentile": 71.12, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 62.14 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 124.28, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 118.07, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "*RL DRUG SCREEN WOUND CENTER", "code_information": [ { "code": "80307", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 150, "discounted_cash": 62, "minimum": 4.5, "maximum": 280.95, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 75, "median_amount": 121.23, "10th_percentile": 121.23, "90th_percentile": 135, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 120.55, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 62.14, "10th_percentile": 31.7, "90th_percentile": 62.14, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 62.14 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 62.14 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 111.85, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 90.1, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 62.14 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 62.14 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 108.12, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 121.79, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 83.89, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 62.14 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 63.38, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 120.55, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 120.55, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 124.28, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 68.35, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 123.04, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 120.55, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 62.14 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 71.12, "10th_percentile": 71.12, "90th_percentile": 71.12, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 62.14 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 124.28, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 118.07, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "*RL CARDIOLIPIN AB IGA", "code_information": [ { "code": "86147", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 28.2, "discounted_cash": 25, "minimum": 8.46, "maximum": 28.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.2, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 39.48, "10th_percentile": 39.48, "90th_percentile": 50.9, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 25.45 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 25.45 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.2, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 28.2, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 25.45 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 25.45 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.2, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.2, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.2, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.45 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.96, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.2, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.2, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.2, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.2, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.45 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 12.41, "10th_percentile": 12.41, "90th_percentile": 12.41, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 25.45 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.2, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "*RL HANTAVIRUS ANTIBODIES, ELISA", "code_information": [ { "code": "86790", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 449.73, "discounted_cash": 12, "minimum": 5.4, "maximum": 449.73, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.99, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 12.88 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 12.88 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.18, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 12.88 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 12.88 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.24, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.39, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.88 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.14, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.99, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.99, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.76, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.17, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.5, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.99, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.88 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 12.88 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.76, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.47, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "*RL HISTAMINE DETERMINATION, URINE", "code_information": [ { "code": "82088", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 100, "discounted_cash": 40, "minimum": 12.69, "maximum": 100, "payers_information": [ { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 79.06, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 40.75 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 40.75 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 73.35, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 59.09, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 40.75 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 40.75 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 70.91, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 57.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 79.87, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 55.01, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.75 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.57, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 79.06, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 79.06, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 81.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.83, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 80.69, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 79.06, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.75 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 40.75 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 81.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 77.43, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "*RL ENTEROVIRUS RT-PCR", "code_information": [ { "code": "87498", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 204, "discounted_cash": 35, "minimum": 35.09, "maximum": 204, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 68.07, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 63.16, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 50.88, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 61.06, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 68.78, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 47.37, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.79, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 68.07, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 68.07, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 70.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 69.48, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 68.07, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 70.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 66.67, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "*RL CARDIOLIPIN AB IGG", "code_information": [ { "code": "86147", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 28.2, "discounted_cash": 25, "minimum": 8.46, "maximum": 28.2, "payers_information": [ { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.2, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.2, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.45 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 12.41, "10th_percentile": 12.41, "90th_percentile": 12.41, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 25.45 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.2, "additional_payer_notes": "190.00% of Medicare Rates" }, { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.2, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 39.48, "10th_percentile": 39.48, "90th_percentile": 50.9, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 25.45 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 25.45 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.2, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 28.2, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 25.45 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 25.45 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.2, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.2, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.2, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.45 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.96, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.2, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.2, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28, "additional_payer_notes": "110.00% of Medicare Rates" } ] } ] }, { "description": "*RL HCV FIBRO SURE", "code_information": [ { "code": "81596", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 368.4, "discounted_cash": 72, "minimum": 72.19, "maximum": 368.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 72.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 140.05, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 72.19 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 72.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 72.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 129.94, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 104.68, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 72.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 125.61, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 101.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 141.49, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 97.46, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 73.63, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 140.05, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 140.05, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 144.38, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 79.41, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 142.94, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 140.05, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 72.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 72.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 72.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 162.1, "10th_percentile": 162.1, "90th_percentile": 162.1, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 72.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 72.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 144.38, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 72.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 137.16, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "*RL HEPATITIS C GENOTYPING BY PCR", "code_information": [ { "code": "87902", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 237, "discounted_cash": 257, "minimum": 71.1, "maximum": 237, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 237, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 237, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 237 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 237, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 237 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 237, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 237, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 237, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 237 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 237 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 237, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 237, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 237, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 237, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 237, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 237 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 237, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 237, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 237, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 237, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 237, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 237, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 237, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 237 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 237, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 237, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 237, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 237 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 237, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 237, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 237, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 237, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 237, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "*RL DHEA SULFATE", "code_information": [ { "code": "82627", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 162.9, "discounted_cash": 22, "minimum": 22.23, "maximum": 162.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 75, "median_amount": 122.18, "10th_percentile": 122.18, "90th_percentile": 122.18, "count": "1 through 10" }, { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.13, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 22.23, "10th_percentile": 22.23, "90th_percentile": 22.23, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 22.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 22.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 22.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 40.01, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 32.23, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 22.23 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 22.23 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 38.68, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.57, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.01, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.23 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.67, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.13, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.13, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 44.46, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.45, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 44.02, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.13, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.23 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 22.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 71.68, "10th_percentile": 71.68, "90th_percentile": 71.68, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 22.23 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 44.46, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 42.24, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "*RL HCV QUANT, RNA RFLX TO GENOTY 550090", "code_information": [ { "code": "87522", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 200.37, "discounted_cash": 42, "minimum": 42.84, "maximum": 222, "payers_information": [ { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 83.11, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 42.84 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 42.84 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 77.11, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 62.12, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 42.84 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 42.84 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 74.54, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 59.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 83.97, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 57.83, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42.84 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.7, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 83.11, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 83.11, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 85.68, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.12, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 84.82, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 83.11, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42.84 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 72.03, "10th_percentile": 72.03, "90th_percentile": 97.68, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 42.84 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 85.68, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 81.4, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "*RL LACOSAMIDE (VIMPAT) SERUM", "code_information": [ { "code": "80339", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 250, "minimum": 5, "maximum": 250, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 5 } ] } ] }, { "description": "*RL HLA B5701", "code_information": [ { "code": "81381", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 187.5, "discounted_cash": 169, "minimum": 56.25, "maximum": 187.5, "payers_information": [ { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 169.9 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 169.9 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 169.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 169.9 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.3, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 186.89, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 169.9 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 169.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 169.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 169.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 169.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 169.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 169.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 169.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 169.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 169.9 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 169.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 169.9 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 169.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "180.00% of Medicare Rates" } ] } ] }, { "description": "*RL FEBRILE ANTIBODY PROFILE", "code_information": [ { "code": "86757", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 341.58, "discounted_cash": 19, "minimum": 10.2, "maximum": 341.58, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 37.54, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 19.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 19.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.83, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 28.06, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 19.35 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 19.35 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.67, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 37.93, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.12, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.35 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 37.54, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 37.54, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 38.7, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.29, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 38.31, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 37.54, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.35 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 19.35 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 38.7, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.77, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "*RL HISTAMINE - PLASMA", "code_information": [ { "code": "83088", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 85.5, "discounted_cash": 29, "minimum": 12.825, "maximum": 85.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 57.29, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 29.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 29.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 29.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 53.15, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 42.82, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 29.53 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 29.53 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 51.38, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 57.88, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 39.87, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.53 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.12, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 57.29, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 57.29, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 59.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.48, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 58.47, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 57.29, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.53 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 29.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 29.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 29.53 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 59.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 56.11, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "*RL LYME DISEASE RT PCR", "code_information": [ { "code": "87476", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 177, "discounted_cash": 35, "minimum": 18, "maximum": 177, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 68.07, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 63.16, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 50.88, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 61.06, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 68.78, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 47.37, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.79, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 68.07, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 68.07, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 70.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 69.48, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 68.07, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 70.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 66.67, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "*RL HLA CLASS 1.2 ANTIBODY SCREEN", "code_information": [ { "code": "86828", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 65, "discounted_cash": 64, "minimum": 19.5, "maximum": 65, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 65, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 64.19 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 64.19 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 65, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 65, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 64.19 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 64.19 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 65, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 65, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 65, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 64.19 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 65, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 65, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 65, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 65, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 65, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 64.19 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 64.19 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 65, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 65, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "*RL GLUTEN SENSITIVITY SCREEN", "code_information": [ { "code": "83516", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 180, "discounted_cash": 11, "minimum": 4.5, "maximum": 337.2, "payers_information": [ { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.37, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 11.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 11.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.75, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 11.53 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 11.53 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.06, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.6, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.57, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.53 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.76, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.37, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.37, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.83, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.37, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.53 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 6.6, "10th_percentile": 6.6, "90th_percentile": 44.88, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 11.53 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.91, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "*RL PROGESTERONE FREE", "code_information": [ { "code": "84999", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 219.65, "minimum": 2.85, "maximum": 240, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "percent of total billed charges", "standard_charge_percentage": 15, "median_amount": 128.51, "10th_percentile": 128.51, "90th_percentile": 128.51, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 96.65, "10th_percentile": 96.65, "90th_percentile": 96.65, "count": "1 through 10" } ] } ] }, { "description": "*RL MANGANESE", "code_information": [ { "code": "83785", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 168.6, "discounted_cash": 26, "minimum": 26.65, "maximum": 168.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 51.7, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 26.65 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 26.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 26.65 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 47.97, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 38.64, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 26.65 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 26.65 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 46.37, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52.23, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 35.98, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.65 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.18, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 51.7, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 51.7, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 53.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.32, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52.77, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 51.7, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.65 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 26.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 26.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 26.65 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 53.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 50.64, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "*RL INFLUENZA AB AND COVID-19", "code_information": [ { "code": "87636", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 250, "discounted_cash": 142, "minimum": 75, "maximum": 250, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 142.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 250, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 142.63 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 142.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 142.63 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 142.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 250, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 206.81, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 142.63 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 142.63 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 142.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 248.18, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 199.68, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 250, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 192.55, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 142.63 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 145.48, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 250, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 250, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 250, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 156.89, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 250, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 250, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 142.63 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 142.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 142.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 142.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 142.63 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 142.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 142.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 250, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 142.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 250, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "*RL HCV RT-PCR QUANT (NON-GRAPH) 550080", "code_information": [ { "code": "87522", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 222, "discounted_cash": 42, "minimum": 42.84, "maximum": 222, "payers_information": [ { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 83.11, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 42.84 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 42.84 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 77.11, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 62.12, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 42.84 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 42.84 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 74.54, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 59.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 83.97, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 57.83, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42.84 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.7, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 83.11, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 83.11, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 85.68, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.12, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 84.82, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 83.11, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42.84 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 72.03, "10th_percentile": 72.03, "90th_percentile": 97.68, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 42.84 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 85.68, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 81.4, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "*RL PROSTAGLANDINS: D2, S", "code_information": [ { "code": "84150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 855, "discounted_cash": 41, "minimum": 41.77, "maximum": 855, "payers_information": [ { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 81.87, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 56.39, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.77 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.61, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 81.03, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 81.03, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 83.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 45.95, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 82.7, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 81.03, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.77 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 41.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 41.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 41.77 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 83.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 79.36, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 81.03, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 41.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 41.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 41.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 75.19, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 60.57, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 41.77 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 41.77 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 72.68, "additional_payer_notes": "174.00% of Medicare Rates" } ] } ] }, { "description": "*RL OVA & PARASIT URINE", "code_information": [ { "code": "87177", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 72.5, "discounted_cash": 8, "minimum": 8.9, "maximum": 72.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 8.9 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 8.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 8.9 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.02, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 12.91, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 8.9 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 8.9 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.49, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.44, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.02, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.9 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.08, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.79, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.62, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.9 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 8.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 8.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.91, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "*RL THIOPURINE METHYLTRANSFERASE", "code_information": [ { "code": "82657", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 405, "discounted_cash": 22, "minimum": 22.17, "maximum": 415.41, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.01, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 22.17, "10th_percentile": 22.17, "90th_percentile": 22.17, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 22.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 22.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 39.91, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 32.15, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 22.17 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 22.17 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 38.58, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.45, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.93, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.17 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.61, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.01, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.01, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 44.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.39, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.9, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.01, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.17 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 22.17 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 44.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 42.12, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "*RL HEPATITIS C RNA BY PCR", "code_information": [ { "code": "87522", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 163.71, "discounted_cash": 42, "minimum": 42.84, "maximum": 222, "payers_information": [ { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 83.11, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 42.84 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 42.84 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 77.11, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 62.12, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 42.84 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 42.84 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 74.54, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 59.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 83.97, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 57.83, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42.84 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.7, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 83.11, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 83.11, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 85.68, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.12, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 84.82, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 83.11, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42.84 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 72.03, "10th_percentile": 72.03, "90th_percentile": 97.68, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 42.84 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 85.68, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 81.4, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "*RL SULFONYL UREA SCREEN URINE", "code_information": [ { "code": "80377", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 327.75, "minimum": 7.77, "maximum": 327.75, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 7.77 } ] } ] }, { "description": "*RL PAI-1 GENE POLYMORPHISM", "code_information": [ { "code": "81400", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 470.37, "discounted_cash": 63, "minimum": 63.96, "maximum": 581.64, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 63.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 124.08, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 63.96 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 63.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 63.96 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 63.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 115.13, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 92.74, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 63.96 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 63.96 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 63.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 111.29, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 89.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 125.36, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 86.35, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 63.96 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65.24, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 124.08, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 124.08, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 127.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 70.36, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 126.64, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 124.08, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 63.96 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 63.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 63.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 63.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 63.96 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 63.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 63.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 127.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 63.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 121.52, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "..TEST HSV CULTURE AND TYPING", "code_information": [ { "code": "87255", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 70, "discounted_cash": 33, "minimum": 21, "maximum": 70, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 65.69, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 33.86 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 33.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 33.86 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 60.95, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 49.1, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 33.86 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 33.86 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 58.92, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.4, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 66.37, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 45.71, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.86 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.54, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 65.69, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 65.69, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 67.72, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.25, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 67.04, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 65.69, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.86 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 33.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 33.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 33.86 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 67.72, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 64.33, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "*RL INHIBIN A", "code_information": [ { "code": "86336", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 244.35, "discounted_cash": 15, "minimum": 15.59, "maximum": 244.35, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.24, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 15.59 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 15.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 15.59 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.06, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 22.61, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 15.59 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 15.59 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.13, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.56, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.59 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.9, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.24, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.24, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.15, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.87, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.24, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.59 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 15.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 15.59 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.62, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "..TEST CULTURE AFB", "code_information": [ { "code": "87556", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 70, "discounted_cash": 41, "minimum": 21, "maximum": 267.66, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 41.68 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 41.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 41.68 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 60.44, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 41.68 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 41.68 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 56.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.68 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 45.85, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.68 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 41.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 41.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 41.68 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "*RL VARICELLA ZOSTER BY PCR", "code_information": [ { "code": "87798", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 371.64, "discounted_cash": 35, "minimum": 18.3, "maximum": 1653.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 68.07, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 63.16, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 50.88, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 61.06, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 68.78, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 47.37, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.79, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 68.07, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 68.07, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 70.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 69.48, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 68.07, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 47.2, "10th_percentile": 47.2, "90th_percentile": 47.2, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 70.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 66.67, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": ".RSV NAA CHARGE ONLY", "code_information": [ { "code": "87634", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 140, "discounted_cash": 70, "minimum": 42, "maximum": 140, "payers_information": [ { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 136.19, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 140, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 77.22, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 139, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 136.19, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 70.2 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 70.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 70.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 70.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 61.6, "10th_percentile": 61.6, "90th_percentile": 61.6, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 70.2 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 70.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 70.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 140, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 70.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 133.38, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 70.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 136.19, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 70.2 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 70.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 70.2 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 70.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 126.36, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 101.79, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 70.2 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 70.2 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 70.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 122.15, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 98.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 137.59, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 94.77, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 70.2 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.6, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 136.19, "additional_payer_notes": "194.00% of Medicare Rates" } ] } ] }, { "description": "*RL LUPUS PROFILE A", "code_information": [ { "code": "86225", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 180.05, "discounted_cash": 13, "minimum": 6, "maximum": 180.05, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.66, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 13.74 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 13.74 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.73, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 19.92, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 13.74 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 13.74 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.91, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.93, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.55, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.74 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.01, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.66, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.66, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.11, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.21, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.66, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.74 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 8.8, "10th_percentile": 8.8, "90th_percentile": 25.08, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 13.74 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.11, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "..TEST CULTURE CAMPYLOBACTER", "code_information": [ { "code": "87046", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 101.8, "discounted_cash": 9, "minimum": 4.8, "maximum": 101.8, "payers_information": [ { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.31, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 9.44 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 9.44 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.99, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 13.69, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 9.44 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 9.44 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.43, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.5, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.74, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.44 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.63, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.31, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.31, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.38, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.69, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.31, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.44 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 9.44 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.94, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "*RL VEGF PLASMA", "code_information": [ { "code": "83520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 450, "discounted_cash": 17, "minimum": 6.9, "maximum": 850, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.5, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 35, "10th_percentile": 35, "90th_percentile": 50.4, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 17.27 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 17.27 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.09, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 25.04, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 17.27 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 17.27 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.05, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.85, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.31, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.27 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.62, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.5, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.5, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.19, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.5, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.27 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 17.27 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.81, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "1.5MM T-PLATE 3 HOLES HEAD 8 HOLES SHAF", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 3430.7, "10th_percentile": 777, "90th_percentile": 3658.2, "count": "1 through 10" } ] } ] }, { "description": "*RL MUSK ANTIBODY TEST", "code_information": [ { "code": "83519", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1200, "discounted_cash": 18, "minimum": 4.5, "maximum": 1200, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.7, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 18.4, "10th_percentile": 18.4, "90th_percentile": 18.4, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 18.4 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 18.4 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.12, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 26.68, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 18.4 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 18.4 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.02, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.06, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.84, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.4 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.77, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.7, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.7, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.43, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.7, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.4 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 18.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.96, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "..TEST CULTURE PERTUSSIS", "code_information": [ { "code": "87070", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 61.05, "discounted_cash": 8, "minimum": 4.5, "maximum": 80, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 75, "median_amount": 60, "10th_percentile": 60, "90th_percentile": 60, "count": "1 through 10" }, { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 8.62, "10th_percentile": 8.62, "90th_percentile": 8.62, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.52, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 12.5, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.9, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.64, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.79, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.24, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.48, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.07, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 35.2, "10th_percentile": 35.2, "90th_percentile": 35.2, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.24, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "..TEST C DIFFICILE CYTOTOXIN B", "code_information": [ { "code": "87230", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 61.05, "discounted_cash": 19, "minimum": 12.15, "maximum": 61.05, "payers_information": [ { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 38.3, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 19.74 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 19.74 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.53, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 28.62, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 19.74 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 19.74 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.35, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 38.69, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.65, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.74 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.13, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 38.3, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 38.3, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 39.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.71, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 39.09, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 38.3, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.74 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 19.74 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 39.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 37.51, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "1.6MM VA LCP FIRST TMT FUSION PLATE LRG", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 3430.7, "10th_percentile": 777, "90th_percentile": 3658.2, "count": "1 through 10" } ] } ] }, { "description": "*RL NATURAL KILLER CELL FUNCTION", "code_information": [ { "code": "86849", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 610, "minimum": 65.07, "maximum": 610, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 65.07 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 65.07 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 65.07 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 65.07 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 65.07 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 65.07 } ] } ] }, { "description": "..TEST FUNGAL ID MOLD", "code_information": [ { "code": "87107", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 153, "discounted_cash": 10, "minimum": 10.32, "maximum": 153, "payers_information": [ { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.02, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 10.32 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 10.32 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.58, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 14.96, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 10.32 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 10.32 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.96, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.23, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.93, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.32 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.53, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.02, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.02, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.35, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.43, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.02, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.32 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 10.32 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "..TEST CULTURE STOOL", "code_information": [ { "code": "87045", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 101.8, "discounted_cash": 9, "minimum": 9.44, "maximum": 101.8, "payers_information": [ { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.31, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 9.44 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 9.44 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.99, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 13.69, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 9.44 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 9.44 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.43, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.5, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.74, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.44 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.63, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.31, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.31, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.38, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.69, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.31, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.44 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 44.79, "10th_percentile": 44.79, "90th_percentile": 44.79, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 9.44 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.94, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "*RL PANCREATIC ELASTASE, FECAL", "code_information": [ { "code": "82656", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 525, "discounted_cash": 11, "minimum": 11.53, "maximum": 525, "payers_information": [ { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.53 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.76, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.37, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.37, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.83, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.37, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.53 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 11.53 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.91, "additional_payer_notes": "190.00% of Medicare Rates" }, { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.37, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 11.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 11.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.75, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 11.53 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 11.53 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.06, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.6, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.57, "additional_payer_notes": "135.00% of Medicare Rates" } ] } ] }, { "description": ".INFLUENZA A NAA CHARGE", "code_information": [ { "code": "87502", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 200, "discounted_cash": 95, "minimum": 60, "maximum": 200, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 75, "median_amount": 150, "10th_percentile": 150, "90th_percentile": 150, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 95.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 185.85, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 95.8, "10th_percentile": 95.8, "90th_percentile": 95.8, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 95.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 95.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 95.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 95.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 172.44, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 138.91, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 95.8 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 95.8 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 95.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 166.69, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 134.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 187.77, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 129.33, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 95.8 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 97.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 185.85, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 185.85, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 191.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.38, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 189.68, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 185.85, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 95.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 95.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 95.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 95.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 88, "10th_percentile": 88, "90th_percentile": 88, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 95.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 95.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 95.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 191.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 95.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 182.02, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "1.3MM STRAIGHT PLATE 12 HOLES", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 3430.7, "10th_percentile": 777, "90th_percentile": 3658.2, "count": "1 through 10" } ] } ] }, { "description": "17 ALPHA HYDROXYPROGESTERONE", "code_information": [ { "code": "83498", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 100, "discounted_cash": 27, "minimum": 27.17, "maximum": 100, "payers_information": [ { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52.71, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 27.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 27.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 48.91, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 39.4, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 27.17 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 27.17 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 47.28, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 53.25, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.68, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.17 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.71, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52.71, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52.71, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 54.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.89, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 53.8, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52.71, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.17 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 27.17 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 54.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 51.62, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "*RL PORPHYRINS, FECAL", "code_information": [ { "code": "84126", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 573, "discounted_cash": 39, "minimum": 39.11, "maximum": 573, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 75.87, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 39.11 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 39.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 39.11 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 70.4, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 56.71, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 39.11 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 39.11 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 68.05, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 54.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 76.66, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 52.8, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.11 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.89, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 75.87, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 75.87, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 78.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.02, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 77.44, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 75.87, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.11 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 39.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 39.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 39.11 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 78.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 74.31, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "1.3MM T-PLATE 3 HOLES HEAD 8 HOLES SHAF", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 3430.7, "10th_percentile": 777, "90th_percentile": 3658.2, "count": "1 through 10" } ] } ] }, { "description": "1.5MM LCP T-PLATE 4HHEAD 8H SHAFT WGUI", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 3430.7, "10th_percentile": 777, "90th_percentile": 3658.2, "count": "1 through 10" } ] } ] }, { "description": "17-HYDROXYCORTICOSTEROIDS", "code_information": [ { "code": "83491", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 31, "discounted_cash": 17, "minimum": 9.3, "maximum": 31, "payers_information": [ { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 17.9 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 17.9 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 25.96, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 17.9 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 17.9 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.17, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.9 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.26, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.69, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.9 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 17.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "*RL PROGESTERONE", "code_information": [ { "code": "84144", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 33.7, "discounted_cash": 20, "minimum": 10.11, "maximum": 33.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 75, "median_amount": 25.28, "10th_percentile": 25.28, "90th_percentile": 25.28, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.7, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 20.86, "10th_percentile": 9.06, "90th_percentile": 20.86, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 20.86 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 20.86 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.7, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 30.25, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 20.86 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 20.86 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.7, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.7, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.16, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.86 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.28, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.7, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.7, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.7, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.95, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.7, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.7, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.86 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 14.83, "10th_percentile": 14.83, "90th_percentile": 14.83, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 20.86 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.7, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.7, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "1.5MM CONDYLAR PLATE 7 HOLES36MM-LEFT", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 3430.7, "10th_percentile": 777, "90th_percentile": 3658.2, "count": "1 through 10" } ] } ] }, { "description": "17-HYDROXYPROGESTERONE", "code_information": [ { "code": "83498", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 100, "discounted_cash": 27, "minimum": 27.17, "maximum": 100, "payers_information": [ { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52.71, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 27.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 27.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 48.91, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 39.4, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 27.17 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 27.17 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 47.28, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 53.25, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.68, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.17 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.71, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52.71, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52.71, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 54.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.89, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 53.8, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52.71, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.17 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 27.17 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 54.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 51.62, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "2.0MM 7 HOLES39MM-LEFT CONDYLAR PLATE", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 3430.7, "10th_percentile": 777, "90th_percentile": 3658.2, "count": "1 through 10" } ] } ] }, { "description": "*RL SMITH ANTIBODIES", "code_information": [ { "code": "86235", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 89.9, "discounted_cash": 17, "minimum": 7.5, "maximum": 182.5, "payers_information": [ { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.78, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 62.93, "10th_percentile": 51.31, "90th_percentile": 127.75, "count": "14" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 17.93 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 17.93 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.27, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 17.93 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 17.93 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.2, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.14, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.21, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.93 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.29, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.78, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.78, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.72, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.5, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.78, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.93 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 35.2, "10th_percentile": 11, "90th_percentile": 80.3, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 17.93 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.07, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "1.5MM EXTENDED H-PLATELEFT", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 3430.7, "10th_percentile": 777, "90th_percentile": 3658.2, "count": "1 through 10" } ] } ] }, { "description": "1st DEGREE BURN INITAL TREATMENT", "code_information": [ { "code": "16000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 873.65, "discounted_cash": 211, "minimum": 45, "maximum": 873.65, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 211.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 409.79, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 873.65 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance Off Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 873.65 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance On Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 873.65 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 873.65 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "case rate", "standard_charge_dollar": 873.65 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 211.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 190.59 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 211.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 380.21, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 306.28, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 190.59 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 190.59 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 211.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 367.54, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 295.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 414.01, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 285.16, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 190.59 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 215.45, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 409.79, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 409.79, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 422.46, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 232.35, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 418.24, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 409.79, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 190.59 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 211.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 211.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 211.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 190.59 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 211.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 211.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 422.46, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 211.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 401.34, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "2.0MM 8 HOLES51MM LC-DCP PLATE", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 3430.7, "10th_percentile": 777, "90th_percentile": 3658.2, "count": "1 through 10" } ] } ] }, { "description": "*RL TESTOSTERONE, FREE+WEAKLY BOUND", "code_information": [ { "code": "84410", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 65.2, "discounted_cash": 51, "minimum": 19.56, "maximum": 65.2, "payers_information": [ { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 65.2, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 65.2, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 51.28 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 51.28 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 65.2, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 65.2, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 65.2, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 51.28 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.31, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 65.2, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 65.2, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 65.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 56.41, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 65.2, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 65.2, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 51.28 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 51.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 51.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 51.28 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 65.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 65.2, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 65.2, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 51.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 51.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 51.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.28, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "2.0MM LC-DCP PLATE 4 HOLES27MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 3430.7, "10th_percentile": 777, "90th_percentile": 3658.2, "count": "1 through 10" } ] } ] }, { "description": "2.0MM LCP CONDYLAR PLT 7HOLES SHAFT", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 3430.7, "10th_percentile": 777, "90th_percentile": 3658.2, "count": "1 through 10" } ] } ] }, { "description": "*RL THIOPURINE METABOLITES", "code_information": [ { "code": "80375", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 405, "minimum": 18.54, "maximum": 1525, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 21.53 } ] } ] }, { "description": "10MM130DEG TI CANN TROCH FIX NAIL 170MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 3430.7, "10th_percentile": 777, "90th_percentile": 3658.2, "count": "1 through 10" } ] } ] }, { "description": "2.0MM T-PLATE 2 HOLES HEAD 8 HOLES SHAF", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 3430.7, "10th_percentile": 777, "90th_percentile": 3658.2, "count": "1 through 10" } ] } ] }, { "description": "2.0MM STRAIGHT PLATE 12 HOLES", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 3430.7, "10th_percentile": 777, "90th_percentile": 3658.2, "count": "1 through 10" } ] } ] }, { "description": "*RL VITAMIN B3", "code_information": [ { "code": "84591", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 200, "discounted_cash": 17, "minimum": 17.06, "maximum": 228.05, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.1, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 17.06 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 17.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 17.06 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.71, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 24.74, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 17.06 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 17.06 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.68, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.88, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.44, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.03, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.06 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.4, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.1, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.1, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.12, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.77, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.78, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.1, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.06 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 17.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 17.06 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.12, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.41, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "2.4MM 6 HOLES51MMLC-DCP PLATE", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 3430.7, "10th_percentile": 777, "90th_percentile": 3658.2, "count": "1 through 10" } ] } ] }, { "description": "2.4MM 4 HOLES35MM LC-DCP PLATE", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 3430.7, "10th_percentile": 777, "90th_percentile": 3658.2, "count": "1 through 10" } ] } ] }, { "description": "..TEST OVA & PARASITE*", "code_information": [ { "code": "87177", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 72.5, "discounted_cash": 8, "minimum": 8.9, "maximum": 72.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 8.9 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 8.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 8.9 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.02, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 12.91, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 8.9 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 8.9 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.49, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.44, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.02, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.9 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.08, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.79, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.62, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.9 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 8.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 8.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.91, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "2.4MM STRAIGHT PLATE 12 HOLES", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 3430.7, "10th_percentile": 777, "90th_percentile": 3658.2, "count": "1 through 10" } ] } ] }, { "description": ".FLU A AG CHARGE ONLY", "code_information": [ { "code": "87449", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 199.04, "discounted_cash": 11, "minimum": 11.98, "maximum": 610, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.24, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 11.98, "10th_percentile": 11.98, "90th_percentile": 11.98, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 11.98 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 11.98 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.56, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 17.37, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 11.98 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 11.98 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.85, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.48, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.17, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.98 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.22, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.24, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.24, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.18, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.72, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.24, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.98 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 87.58, "10th_percentile": 87.58, "90th_percentile": 87.58, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 11.98 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.76, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "2.4MM Y-PLATE 3 HOLES HEAD 8 HOLES SHAF", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 3430.7, "10th_percentile": 777, "90th_percentile": 3658.2, "count": "1 through 10" } ] } ] }, { "description": "3.5MM LC-DCP PLATE 8 HOLES103MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 3430.7, "10th_percentile": 777, "90th_percentile": 3658.2, "count": "1 through 10" } ] } ] }, { "description": ".FLU B AG CHARGE ONLY", "code_information": [ { "code": "87449", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 199.04, "discounted_cash": 11, "minimum": 11.98, "maximum": 610, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.24, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 11.98, "10th_percentile": 11.98, "90th_percentile": 11.98, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 11.98 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 11.98 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.56, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 17.37, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 11.98 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 11.98 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.85, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.48, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.17, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.98 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.22, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.24, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.24, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.18, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.72, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.24, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.98 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 87.58, "10th_percentile": 87.58, "90th_percentile": 87.58, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 11.98 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.76, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "2.0MM STRAIGHT PLATE 6 HOLES", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 3430.7, "10th_percentile": 777, "90th_percentile": 3658.2, "count": "1 through 10" } ] } ] }, { "description": "3.5MM LC-DCP PLATE 6 HOLES77MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 3430.7, "10th_percentile": 777, "90th_percentile": 3658.2, "count": "1 through 10" } ] } ] }, { "description": "3.5MM LCP PLATE 8 HOLES 111MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 3430.7, "10th_percentile": 777, "90th_percentile": 3658.2, "count": "1 through 10" } ] } ] }, { "description": ".RSV AG CHARGE ONLY", "code_information": [ { "code": "87807", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 90, "discounted_cash": 13, "minimum": 13.1, "maximum": 90, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.41, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 13.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 13.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 13.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.58, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 19, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 13.1 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 13.1 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.79, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.68, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.69, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.1 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.36, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.41, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.41, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.41, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.94, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.41, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.1 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 13.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 13.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.89, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "2.0MM T-PLATE 3 HOLES HEAD 8 HOLES SHAF", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 3430.7, "10th_percentile": 777, "90th_percentile": 3658.2, "count": "1 through 10" } ] } ] }, { "description": "3.5MM LCP PERIART PROX HUMER 6H 163MM RT", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 3430.7, "10th_percentile": 777, "90th_percentile": 3658.2, "count": "1 through 10" } ] } ] }, { "description": "2.4MM LCP DISTAL RAD L-PLT 20DEG 3H4H SH", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 3430.7, "10th_percentile": 777, "90th_percentile": 3658.2, "count": "1 through 10" } ] } ] }, { "description": "3.5MM LCP PLATE 10 HOLES 137MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 3430.7, "10th_percentile": 777, "90th_percentile": 3658.2, "count": "1 through 10" } ] } ] }, { "description": "3.5MM LCP RECONSTRUCTION PLATE 7 HOLES9", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 3430.7, "10th_percentile": 777, "90th_percentile": 3658.2, "count": "1 through 10" } ] } ] }, { "description": "2.4MM 8 HOLES67MM LC-DCP PLATE", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 3430.7, "10th_percentile": 777, "90th_percentile": 3658.2, "count": "1 through 10" } ] } ] }, { "description": "2.4MM T-PLATE 3 HOLES HEAD 8 HOLES SHAF", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 3430.7, "10th_percentile": 777, "90th_percentile": 3658.2, "count": "1 through 10" } ] } ] }, { "description": "3.5MM LCP PLATE 14 HOLES 189MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 3430.7, "10th_percentile": 777, "90th_percentile": 3658.2, "count": "1 through 10" } ] } ] }, { "description": "3.5MM RECONSTRUCTION PLATE 6 HOLES70MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 3430.7, "10th_percentile": 777, "90th_percentile": 3658.2, "count": "1 through 10" } ] } ] }, { "description": "28 PLATE 15MM 2-HOLE LOCKING 1.1MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 3430.7, "10th_percentile": 777, "90th_percentile": 3658.2, "count": "1 through 10" } ] } ] }, { "description": "3.5MM LC-DCP PLATE 9 HOLES116MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 3430.7, "10th_percentile": 777, "90th_percentile": 3658.2, "count": "1 through 10" } ] } ] }, { "description": "3.5MM LCP RECONSTRUCTION PLATE 6 HOLES8", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 3430.7, "10th_percentile": 777, "90th_percentile": 3658.2, "count": "1 through 10" } ] } ] }, { "description": "4.5MM BROAD LCP« PLATE 16 HOLES296MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 3430.7, "10th_percentile": 777, "90th_percentile": 3658.2, "count": "1 through 10" } ] } ] }, { "description": "3.5MM LCP PLATE 6 HOLES 85MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 3430.7, "10th_percentile": 777, "90th_percentile": 3658.2, "count": "1 through 10" } ] } ] }, { "description": "4.5MM LCP« T-PLATE 4 HOLES 83MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 3430.7, "10th_percentile": 777, "90th_percentile": 3658.2, "count": "1 through 10" } ] } ] }, { "description": "3.5MM LCP PLATE 12 HOLES 163MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 3430.7, "10th_percentile": 777, "90th_percentile": 3658.2, "count": "1 through 10" } ] } ] }, { "description": "3.5MM LCP RECONSTRUCTION PLATE 8 HOLES1", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 3430.7, "10th_percentile": 777, "90th_percentile": 3658.2, "count": "1 through 10" } ] } ] }, { "description": "3.5MM RECONSTRUCTION PLATE 8 HOLES94MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 3430.7, "10th_percentile": 777, "90th_percentile": 3658.2, "count": "1 through 10" } ] } ] }, { "description": "3.5MM LCP PROXIMAL HUMERUS PLATE-STANDA", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 3430.7, "10th_percentile": 777, "90th_percentile": 3658.2, "count": "1 through 10" } ] } ] }, { "description": "3.5MM LCP T-PLATE 3H HEAD 4H SHAFT63MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 3430.7, "10th_percentile": 777, "90th_percentile": 3658.2, "count": "1 through 10" } ] } ] }, { "description": "3.5MM T-PLATE 3 HOLES HEAD 3 HOLES SHAF - C1713 - 1401505", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 3430.7, "10th_percentile": 777, "90th_percentile": 3658.2, "count": "1 through 10" } ] } ] }, { "description": "5-HIAA 24 HR URINE", "code_information": [ { "code": "83497", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 81.5, "discounted_cash": 12, "minimum": 12.9, "maximum": 214.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.03, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 12.9 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 12.9 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.22, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 18.71, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 12.9 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 12.9 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.45, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.28, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.42, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.9 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.16, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.03, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.03, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.19, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.54, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.03, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.9 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 12.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.51, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "3.5MM LCP RECONSTRUCTION PLATE 10 HOLES", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 3430.7, "10th_percentile": 777, "90th_percentile": 3658.2, "count": "1 through 10" } ] } ] }, { "description": "3.5MM LCP T-PLATE 3H HEAD 5H SHAFT74MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 3430.7, "10th_percentile": 777, "90th_percentile": 3658.2, "count": "1 through 10" } ] } ] }, { "description": "3.5MM T-PLATE 3 HOLES HEAD 3 HOLES SHAF - C1713 - 1401506", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 3430.7, "10th_percentile": 777, "90th_percentile": 3658.2, "count": "1 through 10" } ] } ] }, { "description": "5-HIAA, QN, RANDOM URINE", "code_information": [ { "code": "83497", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 118, "discounted_cash": 12, "minimum": 12.9, "maximum": 214.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.03, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 12.9 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 12.9 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.22, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 18.71, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 12.9 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 12.9 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.45, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.28, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.42, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.9 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.16, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.03, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.03, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.19, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.54, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.03, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.9 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 12.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.51, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "3.5MM RECONSTRUCTION PLATE 10 HOLES118M", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 3430.7, "10th_percentile": 777, "90th_percentile": 3658.2, "count": "1 through 10" } ] } ] }, { "description": "3DMAX MID RIGHT 3X5 8CMX14CM", "code_information": [ { "code": "C1781", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 40, "median_amount": 3069.04, "10th_percentile": 3069.04, "90th_percentile": 3069.04, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 40, "median_amount": 1046.76, "10th_percentile": 1046.76, "90th_percentile": 1046.76, "count": "1 through 10" } ] } ] }, { "description": "7 DEG FULL WEDGE TIBIAL AUGMENT SZ 3", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 3430.7, "10th_percentile": 777, "90th_percentile": 3658.2, "count": "1 through 10" } ] } ] }, { "description": "3.5MM LCP T-PLATE 3H HEAD 3H SHAFT52MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 3430.7, "10th_percentile": 777, "90th_percentile": 3658.2, "count": "1 through 10" } ] } ] }, { "description": "3.5MM RECONSTRUCTION PLATE 5 HOLES58MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 3430.7, "10th_percentile": 777, "90th_percentile": 3658.2, "count": "1 through 10" } ] } ] }, { "description": "4.5MM LCP« T-PLATE 8 HOLES 147MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 3430.7, "10th_percentile": 777, "90th_percentile": 3658.2, "count": "1 through 10" } ] } ] }, { "description": "ABDOMEN AP ONLY(KUB)", "code_information": [ { "code": "74022", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 403, "discounted_cash": 110, "minimum": 91.455, "maximum": 632.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 110.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.54, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 282.1, "10th_percentile": 282.1, "90th_percentile": 282.1, "count": "18" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 110.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 91.46 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 110.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 198.13, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 159.6, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 91.46 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 91.46 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 110.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 191.52, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 215.74, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 148.59, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 91.46 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 112.27, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.54, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Pathfinder Advisor", "plan_name": "Path Finder Advisor Commercial (OP Only) (05-01-2021 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 163.46 }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.54, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 220.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.08, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 217.94, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.54, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 91.46 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 110.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 110.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 110.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 177.32, "10th_percentile": 177.32, "90th_percentile": 177.32, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 91.46 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 110.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 110.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 220.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 110.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 209.13, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "3.5MM LCP T-PLATE 3H HEAD 7H SHAFT87MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 3430.7, "10th_percentile": 777, "90th_percentile": 3658.2, "count": "1 through 10" } ] } ] }, { "description": "3.5MM T-PLATE 3 HOLES HEAD 5 HOLES SHAF - C1713 - 1401502", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 3430.7, "10th_percentile": 777, "90th_percentile": 3658.2, "count": "1 through 10" } ] } ] }, { "description": "5-HIAA PLASMA", "code_information": [ { "code": "83497", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 214.5, "discounted_cash": 12, "minimum": 12.9, "maximum": 214.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.03, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 12.9 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 12.9 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.22, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 18.71, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 12.9 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 12.9 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.45, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.28, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.42, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.9 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.16, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.03, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.03, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.19, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.54, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.03, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.9 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 12.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.51, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ABG ARTERIAL PUNCTURE", "code_information": [ { "code": "36600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 273.54, "discounted_cash": 140, "minimum": 82.062, "maximum": 273.54, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 140.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 271.74, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 273.54 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance Off Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 273.54 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance On Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 273.54 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 273.54 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "case rate", "standard_charge_dollar": 273.54 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 140.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 190.59 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 140.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 252.13, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 203.1, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 190.59 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 190.59 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 140.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 243.72, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 196.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 273.54, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 189.09, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 190.59 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 142.87, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 271.74, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 271.74, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 273.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.08, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 273.54, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 271.74, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 190.59 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 140.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 140.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 140.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 120.36, "10th_percentile": 120.36, "90th_percentile": 120.36, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 190.59 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 140.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 140.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 273.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 140.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 266.13, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "3.5MM LCP T-PLATE 4H HEAD 4H SHAFT56MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 3430.7, "10th_percentile": 777, "90th_percentile": 3658.2, "count": "1 through 10" } ] } ] }, { "description": "4.5MM BROAD LCP PLATE 11 HOLES206MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 3430.7, "10th_percentile": 777, "90th_percentile": 3658.2, "count": "1 through 10" } ] } ] }, { "description": "ABORTION WO D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY - SOI : 4", "code_information": [ { "code": "5644", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 2409.47, "maximum": 2409.47, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 2409.47, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 2409.47 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 2409.47, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 2409.47 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2409.47, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 2409.47, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "3.5MM RECONSTRUCTION PLATE 9 HOLES106MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 3430.7, "10th_percentile": 777, "90th_percentile": 3658.2, "count": "1 through 10" } ] } ] }, { "description": "4.5MM BROAD LCP« PLATE 7 HOLES134MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 3430.7, "10th_percentile": 777, "90th_percentile": 3658.2, "count": "1 through 10" } ] } ] }, { "description": "3.5MM T-PLATE 3 HOLES HEAD 4 HOLES SHAF", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 3430.7, "10th_percentile": 777, "90th_percentile": 3658.2, "count": "1 through 10" } ] } ] }, { "description": "4.5MM LCP« T-PLATE 6 HOLES 115MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 3430.7, "10th_percentile": 777, "90th_percentile": 3658.2, "count": "1 through 10" } ] } ] }, { "description": "ACID FAST STAIN", "code_information": [ { "code": "87206", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 50, "discounted_cash": 5, "minimum": 3, "maximum": 81.45, "payers_information": [ { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.46, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.78, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.93, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.67, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.46, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.39 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 5.39 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.78, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.24, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.46, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 5.39 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 5.39 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 5.39 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 5.39 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.28, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.39 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.46, "additional_payer_notes": "194.00% of Medicare Rates" } ] } ] }, { "description": "3.5MM T-PLATE 3 HOLES HEAD 5 HOLES SHAF - C1713 - 1401503", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 3430.7, "10th_percentile": 777, "90th_percentile": 3658.2, "count": "1 through 10" } ] } ] }, { "description": "ACID PHOSPHATASE TOTAL", "code_information": [ { "code": "84060", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13, "discounted_cash": 7, "minimum": 3.9, "maximum": 13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 7.64 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 7.64 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 11.08, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 7.64 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 7.64 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.31, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.64 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.79, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.4, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.64 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 7.64 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "4.5MM BROAD LCP PLATE 10 HOLES188MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 3430.7, "10th_percentile": 777, "90th_percentile": 3658.2, "count": "1 through 10" } ] } ] }, { "description": "ABD PARACENTESIS", "code_information": [ { "code": "49082", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 914, "discounted_cash": 954, "minimum": 274.2, "maximum": 1155.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 914, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 914, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 914 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance Off Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 914 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance On Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 914 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 914 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "case rate", "standard_charge_dollar": 914 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 914, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 914 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 914, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 914, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 914, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 914 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 914 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 914, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 914, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 914, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 914, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 914, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 914 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 914, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 914, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 914, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 914, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 914, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 914, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 914, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 914 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 914, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 914, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 914, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 914 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 914, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 914, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 914, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 914, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 914, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "9ROD 200MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 3430.7, "10th_percentile": 777, "90th_percentile": 3658.2, "count": "1 through 10" } ] } ] }, { "description": "ACTINOMYCES ANTIBODY", "code_information": [ { "code": "86602", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 110, "discounted_cash": 10, "minimum": 10.18, "maximum": 110, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.75, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 10.18 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 10.18 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.32, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 14.76, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 10.18 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 10.18 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.95, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.18 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.38, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.75, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.75, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.16, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.75, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.18 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 10.18 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.34, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "4.5MM BROAD LCP« PLATE 6 HOLES116MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 3430.7, "10th_percentile": 777, "90th_percentile": 3658.2, "count": "1 through 10" } ] } ] }, { "description": "ABDOMEN ACUTE WITH PA CXR", "code_information": [ { "code": "74022", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 632.9, "discounted_cash": 110, "minimum": 91.455, "maximum": 632.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 110.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.54, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 282.1, "10th_percentile": 282.1, "90th_percentile": 282.1, "count": "18" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 110.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 91.46 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 110.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 198.13, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 159.6, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 91.46 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 91.46 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 110.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 191.52, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 215.74, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 148.59, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 91.46 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 112.27, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.54, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Pathfinder Advisor", "plan_name": "Path Finder Advisor Commercial (OP Only) (05-01-2021 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 163.46 }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.54, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 220.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.08, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 217.94, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.54, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 91.46 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 110.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 110.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 110.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 177.32, "10th_percentile": 177.32, "90th_percentile": 177.32, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 91.46 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 110.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 110.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 220.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 110.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 209.13, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ABD XRAY 1 VIEW", "code_information": [ { "code": "74018", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 413.05, "discounted_cash": 91, "minimum": 91.62, "maximum": 413.05, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 91.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 177.74, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 91.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 242.27 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 91.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 164.92, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 132.85, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 242.27 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 242.27 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 91.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 159.42, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 128.27, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 179.58, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 123.69, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 242.27 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 93.45, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 177.74, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Pathfinder Advisor", "plan_name": "Path Finder Advisor Commercial (OP Only) (05-01-2021 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 121.35 }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 177.74, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 183.24, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 181.41, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 177.74, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 242.27 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 91.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 91.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 91.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 242.27 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 91.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 91.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 183.24, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 91.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.08, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ACTIVASE (CATHFLO) INJ: 2MG", "drug_information": { "unit": 2, "type": "ME" }, "code_information": [ { "code": "50242004164", "type": "NDC" }, { "code": "J2997", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 93, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 542.96, "10th_percentile": 542.96, "90th_percentile": 542.96, "count": "1 through 10" } ] } ] }, { "description": "ABDOMINAL PAIN - SOI : 3", "code_information": [ { "code": "2513", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3318.82, "maximum": 3318.82, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 3318.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 3318.82 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 3318.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 3318.82 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3318.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 3318.82, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ABDOMEN COMPLETE", "code_information": [ { "code": "74019", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 540, "discounted_cash": 110, "minimum": 110.07, "maximum": 540, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 110.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.54, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 378, "10th_percentile": 378, "90th_percentile": 378, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 110.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 446.39 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 110.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 198.13, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 159.6, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 446.39 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 446.39 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 110.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 191.52, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 215.74, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 148.59, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 446.39 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 112.27, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.54, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Pathfinder Advisor", "plan_name": "Path Finder Advisor Commercial (OP Only) (05-01-2021 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 163.46 }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.54, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 220.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.08, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 217.94, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.54, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 446.39 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 110.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 110.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 110.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 237.6, "10th_percentile": 237.6, "90th_percentile": 237.6, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 446.39 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 110.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 110.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 220.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 110.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 209.13, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE & SUBACUTE ENDOCARDITIS - SOI : 4", "code_information": [ { "code": "1934", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7396.94, "maximum": 7396.94, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 7396.94, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 7396.94 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 7396.94, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 7396.94 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7396.94, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 7396.94, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ABDOMINAL PARACENTESIS WOUT GUIDANCE", "code_information": [ { "code": "49082", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1155.9, "discounted_cash": 954, "minimum": 274.2, "maximum": 1155.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 954.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1155.9, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 1155.9 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance Off Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 1155.9 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance On Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 1155.9 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 1155.9 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "case rate", "standard_charge_dollar": 1155.9 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 954.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 1155.9 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 954.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1155.9, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 1155.9, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 1155.9 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 1155.9 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 954.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1155.9, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1155.9, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1155.9, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1155.9, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 1155.9 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 973.99, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1155.9, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1155.9, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1155.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1050.38, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1155.9, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1155.9, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1155.9 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 954.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 954.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 954.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 1155.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 954.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 954.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1155.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 954.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1155.9, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ABDOMINAL PAIN - SOI : 2", "code_information": [ { "code": "2512", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 2667.52, "maximum": 2667.52, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 2667.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 2667.52 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 2667.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 2667.52 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2667.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 2667.52, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH MCC", "code_information": [ { "code": "834", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 42218, "minimum": 42218.36, "maximum": 88402.1, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 84436.72, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "case rate", "standard_charge_dollar": 42218.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "case rate", "standard_charge_dollar": 80214.88, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 42218.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 81903.62, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 42218.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 42218.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 75993.05, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "case rate", "standard_charge_dollar": 61216.62, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "case rate", "standard_charge_dollar": 42218.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 73459.95, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "case rate", "standard_charge_dollar": 54883.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 82747.99, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "plan_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "methodology": "case rate", "standard_charge_dollar": 67549.38, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "case rate", "standard_charge_dollar": 56994.79, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "case rate", "standard_charge_dollar": 43062.77, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 81903.62, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 81903.62, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 84436.72, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 46440.24, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 83592.35, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Fully Insured", "methodology": "case rate", "standard_charge_dollar": 45582.15 }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Self Funded", "methodology": "case rate", "standard_charge_dollar": 48620.92 }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 81903.62, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 42218.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 88402.1 }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 42218.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 76622.53 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 42218.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 42218.4, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ABDOMINAL PAIN - SOI : 1", "code_information": [ { "code": "2511", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 2337.71, "maximum": 2337.71, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 2337.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 2337.71 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 2337.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 2337.71 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2337.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 2337.71, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ABORTION WITHOUT D&C", "code_information": [ { "code": "779", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6783, "minimum": 4452.82, "maximum": 13566.48, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6783.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13159.49, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 6783.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 6783.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12209.83, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "case rate", "standard_charge_dollar": 9835.7, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "case rate", "standard_charge_dollar": 6783.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11802.84, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "case rate", "standard_charge_dollar": 8818.21, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13295.15, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "plan_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "methodology": "case rate", "standard_charge_dollar": 10853.18, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "case rate", "standard_charge_dollar": 9157.37, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "case rate", "standard_charge_dollar": 6918.9, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13159.49, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13159.49, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13566.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7461.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13430.82, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Fully Insured", "methodology": "case rate", "standard_charge_dollar": 6985.24 }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Self Funded", "methodology": "case rate", "standard_charge_dollar": 7450.91 }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13159.49, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6783.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4452.82 }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 6783.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 11742.02 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6783.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 6783.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13566.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "case rate", "standard_charge_dollar": 6783.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "case rate", "standard_charge_dollar": 12888.16, "additional_payer_notes": "190.00% 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": 8013, "minimum": 8013.55, "maximum": 16027.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8013.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15546.29, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 8013.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 8013.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14424.39, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "case rate", "standard_charge_dollar": 11619.65, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "case rate", "standard_charge_dollar": 8013.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13943.58, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "case rate", "standard_charge_dollar": 10417.62, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15706.56, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "plan_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "methodology": "case rate", "standard_charge_dollar": 12821.68, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "case rate", "standard_charge_dollar": 10818.29, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "case rate", "standard_charge_dollar": 8173.82, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15546.29, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15546.29, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16027.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8814.91, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15866.83, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Fully Insured", "methodology": "case rate", "standard_charge_dollar": 8325.33 }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Self Funded", "methodology": "case rate", "standard_charge_dollar": 8880.34 }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15546.29, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8013.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8286.3 }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 8013.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 13994.68 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8013.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 8013.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16027.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "case rate", "standard_charge_dollar": 8013.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "case rate", "standard_charge_dollar": 15225.75, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MAJOR EYE INFECTIONS WITH CCMCC", "code_information": [ { "code": "121", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9237, "minimum": 4686.77, "maximum": 18475.54, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9237.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17921.27, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 9237.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 9237.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16627.99, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "case rate", "standard_charge_dollar": 13394.77, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "case rate", "standard_charge_dollar": 9237.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16073.72, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "case rate", "standard_charge_dollar": 12009.1, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18106.03, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "plan_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "methodology": "case rate", "standard_charge_dollar": 14780.43, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "case rate", "standard_charge_dollar": 12470.99, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "case rate", "standard_charge_dollar": 9422.53, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17921.27, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17921.27, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18475.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10161.55, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18290.78, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Fully Insured", "methodology": "case rate", "standard_charge_dollar": 9658.78 }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Self Funded", "methodology": "case rate", "standard_charge_dollar": 10302.69 }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17921.27, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9237.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4686.77 }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 9237.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 16236.18 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9237.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 9237.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18475.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "case rate", "standard_charge_dollar": 9237.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "case rate", "standard_charge_dollar": 17551.76, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ABDOMINAL PAIN - SOI : 4", "code_information": [ { "code": "2514", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3318.82, "maximum": 3318.82, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 3318.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 3318.82 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 3318.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 3318.82 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3318.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 3318.82, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ABORTION WO D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY - SOI : 3", "code_information": [ { "code": "5643", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 2409.47, "maximum": 2409.47, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 2409.47, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 2409.47 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 2409.47, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 2409.47 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2409.47, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 2409.47, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ABORTION WO D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY - SOI : 1", "code_information": [ { "code": "5641", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 1119.92, "maximum": 1119.92, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 1119.92, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 1119.92 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 1119.92, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 1119.92 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1119.92, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 1119.92, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE MAJOR EYE INFECTIONS WITHOUT CCMCC", "code_information": [ { "code": "122", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6360, "minimum": 3005.44, "maximum": 12720.36, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6360.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12338.75, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 6360.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 6360.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11448.32, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "case rate", "standard_charge_dollar": 9222.26, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "case rate", "standard_charge_dollar": 6360.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11066.71, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "case rate", "standard_charge_dollar": 8268.23, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12465.95, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "plan_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "methodology": "case rate", "standard_charge_dollar": 10176.29, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "case rate", "standard_charge_dollar": 8586.24, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "case rate", "standard_charge_dollar": 6487.38, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12338.75, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12338.75, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12720.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6996.2, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12593.16, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Fully Insured", "methodology": "case rate", "standard_charge_dollar": 6524.43 }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Self Funded", "methodology": "case rate", "standard_charge_dollar": 6959.38 }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12338.75, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6360.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3005.44 }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 6360.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 10967.41 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6360.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 6360.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12720.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "case rate", "standard_charge_dollar": 6360.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "case rate", "standard_charge_dollar": 12084.34, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION - SOI : 1", "code_information": [ { "code": "1901", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3025.61, "maximum": 3025.61, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 3025.61, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 3025.61 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 3025.61, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 3025.61 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3025.61, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 3025.61, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ABORTION WO D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY - SOI : 2", "code_information": [ { "code": "5642", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 2409.47, "maximum": 2409.47, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 2409.47, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 2409.47 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 2409.47, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 2409.47 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2409.47, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 2409.47, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACCUTANE", "code_information": [ { "code": "80299", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 170, "discounted_cash": 18, "minimum": 7.2, "maximum": 850, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.16, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 18.64 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.55, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 27.03, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 18.64 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 18.64 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.43, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.53, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.16, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.64 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.01, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.16, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.16, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 37.28, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.5, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.91, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.16, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.64 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 18.64 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 37.28, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.42, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC", "code_information": [ { "code": "281", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7376, "minimum": 7376.29, "maximum": 14752.58, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7376.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14310, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 7376.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 7376.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13277.32, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "case rate", "standard_charge_dollar": 10695.62, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "case rate", "standard_charge_dollar": 7376.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12834.74, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "case rate", "standard_charge_dollar": 9589.18, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14457.53, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "plan_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "methodology": "case rate", "standard_charge_dollar": 11802.06, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "case rate", "standard_charge_dollar": 9957.99, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "case rate", "standard_charge_dollar": 7523.82, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14310, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14310, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14752.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8113.92, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14605.05, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Fully Insured", "methodology": "case rate", "standard_charge_dollar": 7631.2 }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Self Funded", "methodology": "case rate", "standard_charge_dollar": 8139.94 }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14310, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7376.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9969.57 }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 7376.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 12827.88 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7376.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 7376.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14752.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "case rate", "standard_charge_dollar": 7376.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "case rate", "standard_charge_dollar": 14014.95, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ABSCESS DRAINAGE PLEURAL EMPYENA", "code_information": [ { "code": "32036", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1155.9, "minimum": 346.77, "maximum": 1155.9, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 1155.9 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance Off Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 1155.9 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance On Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 1155.9 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 1155.9 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "case rate", "standard_charge_dollar": 1155.9 } ] } ] }, { "description": "ACETAMINOPHEN", "code_information": [ { "code": "80143", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 214.83, "discounted_cash": 18, "minimum": 18.64, "maximum": 214.83, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.16, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 18.64, "10th_percentile": 18.64, "90th_percentile": 18.64, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 18.64 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 18.64 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.55, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 27.03, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 18.64 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 18.64 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.43, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.53, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.16, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.64 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.01, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.16, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.16, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 37.28, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.5, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.91, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.16, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.64 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 94.53, "10th_percentile": 94.53, "90th_percentile": 94.53, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 18.64 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 37.28, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.42, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ACID PHOSPHATASE PROSTATIC", "code_information": [ { "code": "84066", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 119.75, "discounted_cash": 9, "minimum": 9.66, "maximum": 119.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.74, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 9.66 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 9.66 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.39, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 14.01, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 9.66 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 9.66 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.81, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.93, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.04, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.66 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.85, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.74, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.74, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.32, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.63, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.13, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.74, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.66 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 9.66 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.32, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.35, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ACTH", "code_information": [ { "code": "82024", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 57.5, "discounted_cash": 38, "minimum": 17.25, "maximum": 57.5, "payers_information": [ { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 57.5, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 52.14, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.62 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.39, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 57.5, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 57.5, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 57.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.48, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 57.5, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 57.5, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.62 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 25.3, "10th_percentile": 25.3, "90th_percentile": 25.3, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 38.62 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 57.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 57.5, "additional_payer_notes": "190.00% of Medicare Rates" }, { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 57.5, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 18.27, "10th_percentile": 18.27, "90th_percentile": 18.27, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 38.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 38.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 57.5, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 56, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 38.62 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 38.62 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 57.5, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 54.07, "additional_payer_notes": "140.00% of Medicare Rates" } ] } ] }, { "description": "ACETONE URINE, DIPSTICK", "code_information": [ { "code": "81002", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5, "discounted_cash": 3, "minimum": 1.5, "maximum": 6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 3.48 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 3.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 3.48 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 5, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 3.48 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 3.48 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.7, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.48 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.55, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.83, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.48 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 3.48 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ACTIVATED CLOTTING TIME - CELITE", "code_information": [ { "code": "85347", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 46.72, "discounted_cash": 4, "minimum": 4.28, "maximum": 46.72, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.3, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 4.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 4.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.7, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 6.21, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 4.28 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 4.28 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.45, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.99, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.39, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.28 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.37, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.3, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.3, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.71, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.47, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.3, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.28 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 4.28 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.13, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ADENOVIRUS", "code_information": [ { "code": "87260", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 54, "discounted_cash": 14, "minimum": 14.43, "maximum": 54, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.99, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 14.43 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 14.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 14.43 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.97, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 20.92, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 14.43 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 14.43 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.11, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.28, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.48, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.43 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.99, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.99, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.57, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.99, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.43 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 14.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 14.43 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.42, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE & SUBACUTE ENDOCARDITIS - SOI : 1", "code_information": [ { "code": "1931", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 2580.17, "maximum": 2580.17, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 2580.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 2580.17 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 2580.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 2580.17 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2580.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 2580.17, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ADIPONECTIN", "code_information": [ { "code": "83520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 518.01, "discounted_cash": 17, "minimum": 6.9, "maximum": 850, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.5, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 35, "10th_percentile": 35, "90th_percentile": 50.4, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 17.27 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 17.27 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.09, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 25.04, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 17.27 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 17.27 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.05, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.85, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.31, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.27 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.62, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.5, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.5, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.19, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.5, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.27 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 17.27 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.81, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE & SUBACUTE ENDOCARDITIS - SOI : 2", "code_information": [ { "code": "1932", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3279.67, "maximum": 3279.67, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 3279.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 3279.67 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 3279.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 3279.67 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3279.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 3279.67, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE BRONCHITIS AND RELATED SYMPTOMS - SOI : 3", "code_information": [ { "code": "1453", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3339.11, "maximum": 3339.11, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 3339.11, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 3339.11 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 3339.11, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 3339.11 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3339.11, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 3339.11, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE & SUBACUTE ENDOCARDITIS - SOI : 3", "code_information": [ { "code": "1933", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4471, "maximum": 4471, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 4471, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 4471 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 4471, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 4471 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4471, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 4471, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION", "code_information": [ { "code": "880", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7689, "minimum": 6376.84, "maximum": 15379.16, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7689.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14917.79, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 7689.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 7689.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13841.24, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "case rate", "standard_charge_dollar": 11149.89, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "case rate", "standard_charge_dollar": 7689.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13379.87, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "case rate", "standard_charge_dollar": 9996.45, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15071.58, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "plan_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "methodology": "case rate", "standard_charge_dollar": 12303.33, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "case rate", "standard_charge_dollar": 10380.93, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "case rate", "standard_charge_dollar": 7843.37, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14917.79, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14917.79, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15379.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8458.54, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15225.37, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Fully Insured", "methodology": "case rate", "standard_charge_dollar": 7972.45 }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Self Funded", "methodology": "case rate", "standard_charge_dollar": 8503.94 }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14917.79, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7689.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6376.84 }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 7689.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 13401.51 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7689.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 7689.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15379.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "case rate", "standard_charge_dollar": 7689.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "case rate", "standard_charge_dollar": 14610.2, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE KIDNEY INJURY - SOI : 3", "code_information": [ { "code": "4693", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4264.41, "maximum": 4264.41, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 4264.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 4264.41 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 4264.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 4264.41 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4264.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 4264.41, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC", "code_information": [ { "code": "288", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20998, "minimum": 20998.9, "maximum": 41997.82, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 20998.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 40737.89, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 20998.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 20998.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 37798.04, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "case rate", "standard_charge_dollar": 30448.42, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "case rate", "standard_charge_dollar": 20998.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 36538.1, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "case rate", "standard_charge_dollar": 27298.57, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 41157.86, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "plan_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "methodology": "case rate", "standard_charge_dollar": 33598.26, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "case rate", "standard_charge_dollar": 28348.53, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "case rate", "standard_charge_dollar": 21418.88, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 40737.89, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 40737.89, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 41997.82, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 23098.79, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 41577.84, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Fully Insured", "methodology": "case rate", "standard_charge_dollar": 22469.34 }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Self Funded", "methodology": "case rate", "standard_charge_dollar": 23967.27 }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 40737.89, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20998.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 29025.3 }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 20998.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 37770.43 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 20998.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 20998.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 41997.82, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "case rate", "standard_charge_dollar": 20998.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "case rate", "standard_charge_dollar": 39897.93, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE AND SUBACUTE ENDOCARDITIS WITH CC", "code_information": [ { "code": "289", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13381, "minimum": 7475.73, "maximum": 26762.98, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13381.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25960.09, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 13381.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 13381.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24086.68, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "case rate", "standard_charge_dollar": 19403.16, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "case rate", "standard_charge_dollar": 13381.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23283.79, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "case rate", "standard_charge_dollar": 17395.95, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 26227.72, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "plan_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "methodology": "case rate", "standard_charge_dollar": 21410.38, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "case rate", "standard_charge_dollar": 18065.01, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "case rate", "standard_charge_dollar": 13649.13, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25960.09, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25960.09, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 26762.98, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 14719.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 26495.35, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Fully Insured", "methodology": "case rate", "standard_charge_dollar": 14172.24 }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Self Funded", "methodology": "case rate", "standard_charge_dollar": 15117.04 }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25960.09, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13381.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7475.73 }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 13381.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 23823.2 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13381.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 13381.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 26762.98, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "case rate", "standard_charge_dollar": 13381.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "case rate", "standard_charge_dollar": 25424.83, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE KIDNEY INJURY - SOI : 4", "code_information": [ { "code": "4694", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9596.92, "maximum": 9596.92, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 9596.92, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 9596.92 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 9596.92, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 9596.92 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9596.92, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 9596.92, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CCMCC", "code_information": [ { "code": "290", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7457, "minimum": 7457.09, "maximum": 15750, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14914.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "case rate", "standard_charge_dollar": 7457.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "case rate", "standard_charge_dollar": 14168.47, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7457.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14466.75, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 7457.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 7457.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13422.76, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "case rate", "standard_charge_dollar": 10812.78, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "case rate", "standard_charge_dollar": 7457.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12975.34, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "case rate", "standard_charge_dollar": 9694.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14615.9, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "plan_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "methodology": "case rate", "standard_charge_dollar": 11931.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "case rate", "standard_charge_dollar": 10067.07, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "case rate", "standard_charge_dollar": 7606.23, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14466.75, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14466.75, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14914.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8202.8, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14765.04, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Fully Insured", "methodology": "case rate", "standard_charge_dollar": 7719.22 }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Self Funded", "methodology": "case rate", "standard_charge_dollar": 8233.82 }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14466.75, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7457.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10549.1 }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 7457.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 12975.82 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7457.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 7457.09, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ADMINISTRATION FLU VIRUS VACCINE", "code_information": [ { "code": "G0008", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 29, "discounted_cash": 49, "minimum": 8.7, "maximum": 29, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE BRONCHITIS AND RELATED SYMPTOMS - SOI : 1", "code_information": [ { "code": "1451", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 2033.62, "maximum": 2033.62, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 2033.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 2033.62 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 2033.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 2033.62 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2033.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 2033.62, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE LEUKEMIA - SOI : 2", "code_information": [ { "code": "6902", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10413.48, "maximum": 10413.48, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 10413.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 10413.48 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 10413.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 10413.48 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 10413.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 10413.48, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE BRONCHITIS AND RELATED SYMPTOMS - SOI : 2", "code_information": [ { "code": "1452", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 2369.6, "maximum": 2369.6, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 2369.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 2369.6 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 2369.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 2369.6 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2369.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 2369.6, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ADRENAL PROCEDURES - SOI : 1", "code_information": [ { "code": "4011", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5043.28, "maximum": 5043.28, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 5043.28, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 5043.28 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 5043.28, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 5043.28 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5043.28, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 5043.28, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE BRONCHITIS AND RELATED SYMPTOMS - SOI : 4", "code_information": [ { "code": "1454", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4629.38, "maximum": 4629.38, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 4629.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 4629.38 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 4629.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 4629.38 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4629.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 4629.38, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE LEUKEMIA - SOI : 3", "code_information": [ { "code": "6903", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 21500.01, "maximum": 21500.01, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 21500.01, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 21500.01 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 21500.01, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 21500.01 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 21500.01, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 21500.01, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE LEUKEMIA - SOI : 1", "code_information": [ { "code": "6901", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3430.08, "maximum": 3430.08, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 3430.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 3430.08 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 3430.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 3430.08 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3430.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 3430.08, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AFB COMPLEX, MOLECULAR DETECTION, PCR", "code_information": [ { "code": "87556", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 153, "discounted_cash": 41, "minimum": 21, "maximum": 267.66, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 80.86, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 41.68 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 41.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 41.68 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 75.02, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 60.44, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 41.68 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 41.68 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 72.52, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 81.69, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 56.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.68 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 80.86, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 80.86, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 83.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 45.85, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 82.53, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 80.86, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.68 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 41.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 41.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 41.68 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 83.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 79.19, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE KIDNEY INJURY - SOI : 1", "code_information": [ { "code": "4691", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 2080.01, "maximum": 2080.01, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 2080.01, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 2080.01 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 2080.01, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 2080.01 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2080.01, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 2080.01, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH CC", "code_information": [ { "code": "835", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16269, "minimum": 16269.75, "maximum": 32539.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16269.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 31563.32, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 16269.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 16269.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 29285.55, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "case rate", "standard_charge_dollar": 23591.14, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "case rate", "standard_charge_dollar": 16269.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28309.37, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "case rate", "standard_charge_dollar": 21150.74, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 31888.71, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "plan_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "methodology": "case rate", "standard_charge_dollar": 26031.6, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "case rate", "standard_charge_dollar": 21964.16, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "case rate", "standard_charge_dollar": 16595.2, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 31563.32, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 31563.32, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 32539.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 17896.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 32214.11, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Fully Insured", "methodology": "case rate", "standard_charge_dollar": 17318.21 }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Self Funded", "methodology": "case rate", "standard_charge_dollar": 18472.74 }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 31563.32, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16269.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19589.7 }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 16269.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 29111.51 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16269.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 16269.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 32539.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "case rate", "standard_charge_dollar": 16269.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "case rate", "standard_charge_dollar": 30912.53, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION - SOI : 3", "code_information": [ { "code": "1903", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4215.84, "maximum": 4215.84, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 4215.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 4215.84 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 4215.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 4215.84 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4215.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 4215.84, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AFP L3 CHARGE ONLY", "code_information": [ { "code": "82107", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 125, "discounted_cash": 64, "minimum": 37.5, "maximum": 125, "payers_information": [ { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 64.41 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 64.41 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 112.07, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 90.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 125, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 86.95, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 64.41 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65.7, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 124.96, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 124.96, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 125, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 70.85, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 125, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 124.96, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 64.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 64.41 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 125, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 122.38, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 124.96, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 64.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 64.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 115.94, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 93.39, "additional_payer_notes": "145.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE KIDNEY INJURY - SOI : 2", "code_information": [ { "code": "4692", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 2783.14, "maximum": 2783.14, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 2783.14, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 2783.14 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 2783.14, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 2783.14 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2783.14, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 2783.14, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "836", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9666, "minimum": 9666.16, "maximum": 19332.32, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9666.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18752.35, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 9666.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 9666.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17399.09, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "case rate", "standard_charge_dollar": 14015.93, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "case rate", "standard_charge_dollar": 9666.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16819.12, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "case rate", "standard_charge_dollar": 12566.01, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18945.67, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "plan_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "methodology": "case rate", "standard_charge_dollar": 15465.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "case rate", "standard_charge_dollar": 13049.32, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "case rate", "standard_charge_dollar": 9859.48, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18752.35, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18752.35, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19332.32, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10632.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19139, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Fully Insured", "methodology": "case rate", "standard_charge_dollar": 10125.4 }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Self Funded", "methodology": "case rate", "standard_charge_dollar": 10800.42 }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18752.35, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9666.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13692.4 }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 9666.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 17020.56 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9666.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 9666.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19332.32, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "case rate", "standard_charge_dollar": 9666.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "case rate", "standard_charge_dollar": 18365.7, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION - SOI : 4", "code_information": [ { "code": "1904", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8129.78, "maximum": 8129.78, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 8129.78, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 8129.78 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 8129.78, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 8129.78 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8129.78, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 8129.78, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CCMCC", "code_information": [ { "code": "561", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6498, "minimum": 6498.15, "maximum": 12996.3, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6498.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12606.41, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 6498.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 6498.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11696.67, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "case rate", "standard_charge_dollar": 9422.32, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "case rate", "standard_charge_dollar": 6498.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11306.78, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "case rate", "standard_charge_dollar": 8447.6, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12736.37, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "plan_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "methodology": "case rate", "standard_charge_dollar": 10397.04, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "case rate", "standard_charge_dollar": 8772.5, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "case rate", "standard_charge_dollar": 6628.11, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12606.41, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12606.41, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12996.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7147.97, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12866.34, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Fully Insured", "methodology": "case rate", "standard_charge_dollar": 6674.71 }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Self Funded", "methodology": "case rate", "standard_charge_dollar": 7119.68 }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12606.41, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6498.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9698.73 }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 6498.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 11220.03 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6498.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 6498.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12996.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "case rate", "standard_charge_dollar": 6498.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "case rate", "standard_charge_dollar": 12346.49, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE LEUKEMIA - SOI : 4", "code_information": [ { "code": "6904", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 22255.32, "maximum": 22255.32, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 22255.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 22255.32 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 22255.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 22255.32 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 22255.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 22255.32, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC", "code_information": [ { "code": "283", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15469, "minimum": 14400, "maximum": 30938.72, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15469.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 30010.56, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 15469.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 15469.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 27844.85, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "case rate", "standard_charge_dollar": 22430.57, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "case rate", "standard_charge_dollar": 15469.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 26916.69, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "case rate", "standard_charge_dollar": 20110.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 30319.95, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "plan_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "methodology": "case rate", "standard_charge_dollar": 24750.98, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "case rate", "standard_charge_dollar": 20883.64, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "case rate", "standard_charge_dollar": 15778.79, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 30010.56, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 30010.56, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 30938.72, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 17016.34, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 30629.33, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Fully Insured", "methodology": "case rate", "standard_charge_dollar": 16446.4 }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Self Funded", "methodology": "case rate", "standard_charge_dollar": 17542.82 }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 30010.56, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15469.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 27449.8 }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 15469.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 27646.03 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15469.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 15469.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 30938.72, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "case rate", "standard_charge_dollar": 15469.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "case rate", "standard_charge_dollar": 29391.78, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC", "code_information": [ { "code": "280", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12597, "minimum": 12597.87, "maximum": 25195.74, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12597.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24439.87, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 12597.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 12597.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22676.17, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "case rate", "standard_charge_dollar": 18266.91, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "case rate", "standard_charge_dollar": 12597.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21920.29, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "case rate", "standard_charge_dollar": 16377.27, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24691.83, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "plan_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "methodology": "case rate", "standard_charge_dollar": 20156.59, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "case rate", "standard_charge_dollar": 17007.12, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "case rate", "standard_charge_dollar": 12849.86, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24439.87, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24439.87, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25195.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13857.69, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24943.78, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Fully Insured", "methodology": "case rate", "standard_charge_dollar": 13318.7 }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Self Funded", "methodology": "case rate", "standard_charge_dollar": 14206.6 }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24439.87, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12597.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14788.4 }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 12597.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 22388.42 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12597.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 12597.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25195.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "case rate", "standard_charge_dollar": 12597.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "case rate", "standard_charge_dollar": 23935.95, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "AICD GENERATOR PROCEDURES", "code_information": [ { "code": "245", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 35148, "minimum": 19350, "maximum": 70296.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 35148.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 68187.61, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 35148.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 35148.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 63266.85, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "case rate", "standard_charge_dollar": 50964.96, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "case rate", "standard_charge_dollar": 35148.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 61157.96, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "case rate", "standard_charge_dollar": 45692.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 68890.57, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "plan_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "methodology": "case rate", "standard_charge_dollar": 56237.2, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "case rate", "standard_charge_dollar": 47450.14, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "case rate", "standard_charge_dollar": 35851.27, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 68187.61, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 68187.61, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 70296.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 38663.13, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 69593.54, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Fully Insured", "methodology": "case rate", "standard_charge_dollar": 37881.2 }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Self Funded", "methodology": "case rate", "standard_charge_dollar": 40406.58 }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 68187.61, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 35148.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 52656.2 }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 35148.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 63677.42 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 35148.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 35148.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 70296.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "case rate", "standard_charge_dollar": 35148.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "case rate", "standard_charge_dollar": 66781.68, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION - SOI : 2", "code_information": [ { "code": "1902", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3361.22, "maximum": 3361.22, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 3361.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 3361.22 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 3361.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 3361.22 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3361.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 3361.22, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALBUMIN", "code_information": [ { "code": "82040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 110.9, "discounted_cash": 4, "minimum": 2.4, "maximum": 110.9, "payers_information": [ { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.6, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 4.95 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 4.95 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.91, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 7.18, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 4.95 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 4.95 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.95 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.05, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.6, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.6, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.45, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.8, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.6, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.95 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 48.8, "10th_percentile": 48.8, "90th_percentile": 48.8, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 4.95 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.41, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CCMCC", "code_information": [ { "code": "282", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5882, "minimum": 5882.23, "maximum": 11764.46, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5882.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11411.53, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 5882.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 5882.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10588.01, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "case rate", "standard_charge_dollar": 8529.23, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "case rate", "standard_charge_dollar": 5882.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10235.08, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "case rate", "standard_charge_dollar": 7646.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11529.17, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "plan_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "methodology": "case rate", "standard_charge_dollar": 9411.57, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "case rate", "standard_charge_dollar": 7941.01, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "case rate", "standard_charge_dollar": 5999.87, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11411.53, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11411.53, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11764.46, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6470.45, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11646.82, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Fully Insured", "methodology": "case rate", "standard_charge_dollar": 6003.83 }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Self Funded", "methodology": "case rate", "standard_charge_dollar": 6404.08 }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11411.53, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5882.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8942.52 }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 5882.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 10092.31 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5882.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 5882.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11764.46, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "case rate", "standard_charge_dollar": 5882.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "case rate", "standard_charge_dollar": 11176.24, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ADD INFUSION THERAPY OF A NEW DRUG 1 HR", "code_information": [ { "code": "96367", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 298.75, "discounted_cash": 75, "minimum": 33, "maximum": 528, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 75.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 147.05, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 298.75 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance Off Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 298.75 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance On Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 298.75 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 298.75 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "case rate", "standard_charge_dollar": 298.75 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 75.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 295.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 75.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 136.44, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 109.91, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 295.62 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 295.62 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 75.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 131.89, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 148.57, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 102.33, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 295.62 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 77.32, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 147.05, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 147.05, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 151.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 83.38, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 150.08, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 147.05, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 295.62 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 75.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 75.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 75.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 131.45, "10th_percentile": 131.45, "90th_percentile": 131.45, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 295.62 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 75.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 75.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 151.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 75.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 144.02, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ALBUMIN SERUM CHARGE ONLY", "code_information": [ { "code": "82040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 62.16, "discounted_cash": 4, "minimum": 2.4, "maximum": 110.9, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 4.95 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.91, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 7.18, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 4.95 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 4.95 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.95 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.05, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.6, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.6, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.45, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.8, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.6, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.95 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 4.95 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.41, "additional_payer_notes": "190.00% of Medicare Rates" }, { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.6, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 4.95 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH CC", "code_information": [ { "code": "284", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5646, "minimum": 5646.69, "maximum": 11293.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5646.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10954.58, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 5646.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 5646.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10164.04, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "case rate", "standard_charge_dollar": 8187.7, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "case rate", "standard_charge_dollar": 5646.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9825.24, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "case rate", "standard_charge_dollar": 7340.7, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11067.51, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "plan_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "methodology": "case rate", "standard_charge_dollar": 9034.7, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "case rate", "standard_charge_dollar": 7623.03, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "case rate", "standard_charge_dollar": 5759.62, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10954.58, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10954.58, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11293.38, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6211.36, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11180.45, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Fully Insured", "methodology": "case rate", "standard_charge_dollar": 5747.27 }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Self Funded", "methodology": "case rate", "standard_charge_dollar": 6130.42 }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10954.58, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5646.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7984.4 }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 5646.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 9661.04 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5646.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 5646.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11293.38, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "case rate", "standard_charge_dollar": 5646.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "case rate", "standard_charge_dollar": 10728.71, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ADD KARYOTYPES", "code_information": [ { "code": "88280", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 44, "discounted_cash": 33, "minimum": 13.2, "maximum": 44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 44, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 33.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 33.47 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 44, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 44, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 33.47 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 33.47 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 44, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 44, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 44, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.47 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.14, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 44, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 44, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 44, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 44, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.47 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 33.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 33.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 33.47 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 44, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ALBUMINCREATININE RATIO URINE", "code_information": [ { "code": "82043", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 50, "discounted_cash": 5, "minimum": 5.78, "maximum": 50, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 75, "median_amount": 37.5, "10th_percentile": 37.5, "90th_percentile": 37.5, "count": "1 through 10" }, { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.21, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 35, "10th_percentile": 35, "90th_percentile": 35, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 5.78 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 5.78 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.4, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 8.38, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 5.78 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 5.78 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.06, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.33, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.8, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.78 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.9, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.21, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.21, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.36, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.44, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.21, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.78 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 22, "10th_percentile": 22, "90th_percentile": 22, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 5.78 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.98, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITHOUT CCMCC", "code_information": [ { "code": "285", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4935, "minimum": 4935.48, "maximum": 9870.96, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 4935.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9574.83, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 4935.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 4935.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8883.86, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "case rate", "standard_charge_dollar": 7156.45, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "case rate", "standard_charge_dollar": 4935.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8587.74, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "case rate", "standard_charge_dollar": 6416.12, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9673.54, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "plan_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "methodology": "case rate", "standard_charge_dollar": 7896.77, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "case rate", "standard_charge_dollar": 6662.9, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "case rate", "standard_charge_dollar": 5034.19, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9574.83, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9574.83, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9870.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 5429.03, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9772.25, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Fully Insured", "methodology": "case rate", "standard_charge_dollar": 4972.61 }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Self Funded", "methodology": "case rate", "standard_charge_dollar": 5304.12 }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9574.83, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 4935.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6049.7 }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 4935.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 8358.85 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 4935.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 4935.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9870.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "case rate", "standard_charge_dollar": 4935.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "case rate", "standard_charge_dollar": 9377.41, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ADD NEB TREATMENT", "code_information": [ { "code": "94640", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 747.3, "discounted_cash": 230, "minimum": 15.9, "maximum": 747.3, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 447.23, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 523.11, "10th_percentile": 523.11, "90th_percentile": 523.11, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 230.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 24.84 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 414.95, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 334.27, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 24.84 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 24.84 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 401.12, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 322.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 451.84, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 311.22, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.84 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.14, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 447.23, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 447.23, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 461.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 253.58, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 456.45, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 447.23, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.84 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 230.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 230.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 328.81, "10th_percentile": 154.22, "90th_percentile": 328.81, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 24.84 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 461.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 438.01, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ADDITIONAL CHEMO INFUSION NEW SUBSTANCE", "code_information": [ { "code": "96417", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 218.28, "discounted_cash": 75, "minimum": 65.484, "maximum": 218.28, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 75.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 147.05, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 75.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 158.73 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 75.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 136.44, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 109.91, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 158.73 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 158.73 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 75.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 131.89, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 148.57, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 102.33, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 158.73 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 77.32, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 147.05, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 147.05, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 151.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 83.38, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 150.08, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 147.05, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 158.73 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 75.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 75.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 75.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 158.73 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 75.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 75.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 151.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 75.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 144.02, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ALCOHOL & DRUG DEPENDENCE W REHAB OR REHABDETOX THERAPY - SOI : 1", "code_information": [ { "code": "7721", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 1087.3, "maximum": 1087.3, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 1087.3, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 1087.3 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 1087.3, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 1087.3 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1087.3, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 1087.3, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ADAMTS13 ANTIBODY", "code_information": [ { "code": "83520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 850, "discounted_cash": 17, "minimum": 6.9, "maximum": 850, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.5, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 35, "10th_percentile": 35, "90th_percentile": 50.4, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 17.27 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 17.27 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.09, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 25.04, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 17.27 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 17.27 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.05, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.85, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.31, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.27 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.62, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.5, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.5, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.19, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.5, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.27 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 17.27 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.81, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ADDITIONAL IV INFUSION THXDX EA ADDL HR", "code_information": [ { "code": "96366", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 581, "discounted_cash": 49, "minimum": 28.5, "maximum": 581, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 95.64, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 49.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 73.71 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 88.74, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 71.49, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 73.71 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 73.71 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 85.78, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 69.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 96.63, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 66.56, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73.71 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.29, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 95.64, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 95.64, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 98.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 54.23, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 97.61, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 95.64, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73.71 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 49.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 49.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 296.52, "10th_percentile": 98.84, "90th_percentile": 790.73, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 73.71 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 98.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 93.67, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ADENOVIRUS GROUP ANTIBODIES QUANTITATIVE", "code_information": [ { "code": "86603", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 97.7, "discounted_cash": 12, "minimum": 12.87, "maximum": 97.7, "payers_information": [ { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 12.87 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 12.87 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.39, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.23, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.37, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.87 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.13, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.97, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.97, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.16, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.97, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.87 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 12.87 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.45, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.97, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 12.87 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 12.87 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.17, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 18.66, "additional_payer_notes": "145.00% of Medicare Rates" } ] } ] }, { "description": "ALCOHOL ABUSE & DEPENDENCE - SOI : 3", "code_information": [ { "code": "7753", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3986.79, "maximum": 3986.79, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 3986.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 3986.79 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 3986.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 3986.79 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3986.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 3986.79, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ADH", "code_information": [ { "code": "84588", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 122.2, "discounted_cash": 33, "minimum": 33.94, "maximum": 122.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 65.84, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 33.94 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 33.94 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 61.09, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 49.21, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 33.94 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 33.94 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 59.06, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 66.52, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 45.82, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.94 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.62, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 65.84, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 65.84, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 67.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.33, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 67.2, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 65.84, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.94 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 33.94 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 67.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 64.49, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ALCOHOL ABUSE & DEPENDENCE - SOI : 4", "code_information": [ { "code": "7754", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8336, "maximum": 8336, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 8336, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 8336 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 8336, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 8336 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8336, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 8336, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ADDITIONAL VARIANTS", "code_information": [ { "code": "81276", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 100, "discounted_cash": 193, "minimum": 30, "maximum": 100, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 100 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 100 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 100 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 100 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 100 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 100 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 100 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA", "code_information": [ { "code": "894", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5072, "minimum": 3745.14, "maximum": 10145.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5072.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9841.02, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 5072.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 5072.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9130.84, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "case rate", "standard_charge_dollar": 7355.4, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "case rate", "standard_charge_dollar": 5072.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8826.48, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "case rate", "standard_charge_dollar": 6594.5, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9942.47, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "plan_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "methodology": "case rate", "standard_charge_dollar": 8116.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "case rate", "standard_charge_dollar": 6848.13, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "case rate", "standard_charge_dollar": 5174.14, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9841.02, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9841.02, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10145.38, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 5579.96, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10043.93, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Fully Insured", "methodology": "case rate", "standard_charge_dollar": 5122.07 }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Self Funded", "methodology": "case rate", "standard_charge_dollar": 5463.53 }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9841.02, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5072.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3745.14 }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 5072.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 8610.07 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5072.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 5072.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10145.38, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "case rate", "standard_charge_dollar": 5072.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "case rate", "standard_charge_dollar": 9638.11, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ADMINISTRATION BAMETESEVIMAB", "code_information": [ { "code": "M0245", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1548, "discounted_cash": 464, "minimum": 464.23, "maximum": 1548, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 464.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 900.61, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 464.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 464.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 835.61, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 673.13, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 464.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 807.76, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 649.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 909.89, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 626.71, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 473.51, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 900.61, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 900.61, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 928.46, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 510.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 919.18, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 900.61, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 464.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 464.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 464.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 464.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 464.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 928.46, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 464.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 882.04, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ADRENAL AND PITUITARY PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "615", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11036, "minimum": 6750, "maximum": 22073.46, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11036.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21411.26, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 11036.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 11036.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19866.11, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "case rate", "standard_charge_dollar": 16003.26, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "case rate", "standard_charge_dollar": 11036.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19203.91, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "case rate", "standard_charge_dollar": 14347.71, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21631.99, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "plan_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "methodology": "case rate", "standard_charge_dollar": 17658.77, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "case rate", "standard_charge_dollar": 14899.59, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "case rate", "standard_charge_dollar": 11257.43, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21411.26, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21411.26, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22073.46, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12140.37, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21852.73, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Fully Insured", "methodology": "case rate", "standard_charge_dollar": 11618.26 }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Self Funded", "methodology": "case rate", "standard_charge_dollar": 12392.8 }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21411.26, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11036.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16004.7 }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 11036.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 19530.03 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11036.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 11036.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22073.46, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "case rate", "standard_charge_dollar": 11036.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "case rate", "standard_charge_dollar": 20969.79, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ALCOHOL, NON-BREATH", "code_information": [ { "code": "80320", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 159.33, "minimum": 8.4, "maximum": 159.33, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 11.21 } ] } ] }, { "description": "ADRENAL 21-HYDROXYLASE AUTOANTIBODIES", "code_information": [ { "code": "83519", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 60, "discounted_cash": 18, "minimum": 4.5, "maximum": 1200, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.7, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 18.4, "10th_percentile": 18.4, "90th_percentile": 18.4, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 18.4 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 18.4 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.12, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 26.68, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 18.4 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 18.4 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.02, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.06, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.84, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.4 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.77, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.7, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.7, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.43, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.7, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.4 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 18.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.96, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ADRENAL PROCEDURES - SOI : 2", "code_information": [ { "code": "4012", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7056.97, "maximum": 7056.97, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 7056.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 7056.97 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 7056.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 7056.97 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7056.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 7056.97, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALCOHOLIC LIVER DISEASE - SOI : 3", "code_information": [ { "code": "2803", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5125.92, "maximum": 5125.92, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 5125.92, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 5125.92 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 5125.92, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 5125.92 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5125.92, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 5125.92, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AFB ID DNA PROBE CHARGE ONLY", "code_information": [ { "code": "87149", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 100, "discounted_cash": 20, "minimum": 20.05, "maximum": 100, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 38.9, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 20.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 20.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.09, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 29.07, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 20.05 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 20.05 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.89, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 39.3, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.07, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.05 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.45, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 38.9, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 38.9, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 40.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.06, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 39.7, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 38.9, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.05 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 20.05 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 40.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 38.1, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "AFTERCARE WITH CCMCC", "code_information": [ { "code": "949", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9439, "minimum": 9439.01, "maximum": 23946.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9439.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18311.68, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 9439.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 9439.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16990.22, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "case rate", "standard_charge_dollar": 13686.56, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "case rate", "standard_charge_dollar": 9439.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16423.88, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "case rate", "standard_charge_dollar": 12270.71, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18500.46, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "plan_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "methodology": "case rate", "standard_charge_dollar": 15102.42, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "case rate", "standard_charge_dollar": 12742.66, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "case rate", "standard_charge_dollar": 9627.79, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18311.68, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18311.68, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18878.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10382.91, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18689.24, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Fully Insured", "methodology": "case rate", "standard_charge_dollar": 9877.97 }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Self Funded", "methodology": "case rate", "standard_charge_dollar": 10536.49 }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18311.68, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9439.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23946.4 }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 9439.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 16604.64 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9439.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 9439.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18878.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "case rate", "standard_charge_dollar": 9439.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "case rate", "standard_charge_dollar": 17934.12, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ALK PHOS BONE SPECIFIC", "code_information": [ { "code": "84080", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 26, "discounted_cash": 14, "minimum": 7.5, "maximum": 122.2, "payers_information": [ { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 21.43, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 14.78 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 14.78 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.72, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.95, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.78 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.78 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 14.78 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "190.00% of Medicare Rates" }, { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 14.78 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 14.78 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ADMINISTRATION OF PNEUMOCOCCAL VACCINE", "code_information": [ { "code": "G0009", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 154.35, "discounted_cash": 49, "minimum": 46.305, "maximum": 154.35, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 95.64, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 49.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 88.74, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 71.49, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 85.78, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 69.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 96.63, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 66.56, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.29, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 95.64, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 95.64, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 98.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 54.23, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 97.61, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 95.64, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 49.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 49.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 98.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 93.67, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "AICD LEAD PROCEDURES", "code_information": [ { "code": "265", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 27950, "minimum": 18450, "maximum": 55901.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 27950.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 54224.65, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 27950.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 27950.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 50311.53, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "case rate", "standard_charge_dollar": 40528.73, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "case rate", "standard_charge_dollar": 27950.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 48634.48, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "case rate", "standard_charge_dollar": 36336.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 54783.67, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "plan_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "methodology": "case rate", "standard_charge_dollar": 44721.36, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "case rate", "standard_charge_dollar": 37733.65, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "case rate", "standard_charge_dollar": 28509.82, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 54224.65, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 54224.65, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 55901.7, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 30745.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 55342.68, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Fully Insured", "methodology": "case rate", "standard_charge_dollar": 30041.59 }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Self Funded", "methodology": "case rate", "standard_charge_dollar": 32044.34 }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 54224.65, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 27950.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 38437.7 }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 27950.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 50499.22 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 27950.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 27950.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 55901.7, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "case rate", "standard_charge_dollar": 27950.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "case rate", "standard_charge_dollar": 53106.62, "additional_payer_notes": "190.00% 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": 8954, "minimum": 8954.2, "maximum": 17908.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8954.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17371.15, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 8954.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 8954.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16117.56, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "case rate", "standard_charge_dollar": 12983.59, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "case rate", "standard_charge_dollar": 8954.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15580.31, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "case rate", "standard_charge_dollar": 11640.46, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17550.23, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "plan_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "methodology": "case rate", "standard_charge_dollar": 14326.72, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "case rate", "standard_charge_dollar": 12088.17, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "case rate", "standard_charge_dollar": 9133.28, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17371.15, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17371.15, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17908.4, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9849.62, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17729.32, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Fully Insured", "methodology": "case rate", "standard_charge_dollar": 9349.91 }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Self Funded", "methodology": "case rate", "standard_charge_dollar": 9973.23 }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17371.15, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8954.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15140.7 }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 8954.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 15716.98 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8954.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 8954.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17908.4, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "case rate", "standard_charge_dollar": 8954.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "case rate", "standard_charge_dollar": 17012.98, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ALLERGIC REACTIONS - SOI : 2", "code_information": [ { "code": "8112", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 2537.04, "maximum": 2537.04, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 2537.04, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 2537.04 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 2537.04, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 2537.04 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2537.04, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 2537.04, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ADRENAL AND PITUITARY PROCEDURES WITH CCMCC", "code_information": [ { "code": "614", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17077, "minimum": 12150, "maximum": 34155.52, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17077.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 33130.85, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 17077.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 17077.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 30739.97, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "case rate", "standard_charge_dollar": 24762.75, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "case rate", "standard_charge_dollar": 17077.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 29715.3, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "case rate", "standard_charge_dollar": 22201.14, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 33472.41, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "plan_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "methodology": "case rate", "standard_charge_dollar": 27324.42, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "case rate", "standard_charge_dollar": 23054.98, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "case rate", "standard_charge_dollar": 17419.36, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 33130.85, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 33130.85, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 34155.52, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 18785.58, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 33813.96, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Fully Insured", "methodology": "case rate", "standard_charge_dollar": 18198.32 }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Self Funded", "methodology": "case rate", "standard_charge_dollar": 19411.52 }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 33130.85, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17077.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 26391.7 }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 17077.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 30590.95 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 17077.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 17077.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 34155.52, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "case rate", "standard_charge_dollar": 17077.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "case rate", "standard_charge_dollar": 32447.74, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ALA DEHYDRATASE, WB", "code_information": [ { "code": "82657", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 205.68, "discounted_cash": 22, "minimum": 22.17, "maximum": 415.41, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.01, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 22.17, "10th_percentile": 22.17, "90th_percentile": 22.17, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 22.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 22.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 39.91, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 32.15, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 22.17 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 22.17 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 38.58, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.45, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.93, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.17 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.61, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.01, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.01, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 44.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.39, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.9, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.01, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.17 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 22.17 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 44.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 42.12, "additional_payer_notes": "190.00% 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": 14585, "minimum": 14585.89, "maximum": 29171.78, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14585.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28296.63, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 14585.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 14585.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 26254.6, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "case rate", "standard_charge_dollar": 21149.54, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "case rate", "standard_charge_dollar": 14585.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25379.45, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "case rate", "standard_charge_dollar": 18961.67, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28588.34, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "plan_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "methodology": "case rate", "standard_charge_dollar": 23337.42, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "case rate", "standard_charge_dollar": 19690.95, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "case rate", "standard_charge_dollar": 14877.62, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28296.63, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28296.63, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 29171.78, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 16044.49, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28880.06, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Fully Insured", "methodology": "case rate", "standard_charge_dollar": 15484.1 }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Self Funded", "methodology": "case rate", "standard_charge_dollar": 16516.36 }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28296.63, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14585.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20002.3 }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 14585.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 26028.41 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14585.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 14585.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 29171.78, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "case rate", "standard_charge_dollar": 14585.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "case rate", "standard_charge_dollar": 27713.19, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ALLERGIC REACTIONS WITH MCC", "code_information": [ { "code": "915", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13188, "minimum": 13188.6, "maximum": 26377.28, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13188.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25585.96, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 13188.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 13188.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23739.55, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "case rate", "standard_charge_dollar": 19123.53, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "case rate", "standard_charge_dollar": 13188.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22948.23, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "case rate", "standard_charge_dollar": 17145.18, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25849.73, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "plan_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "methodology": "case rate", "standard_charge_dollar": 21101.82, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "case rate", "standard_charge_dollar": 17804.66, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "case rate", "standard_charge_dollar": 13452.37, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25585.96, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25585.96, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 26377.28, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 14507.46, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 26113.51, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Fully Insured", "methodology": "case rate", "standard_charge_dollar": 13962.17 }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Self Funded", "methodology": "case rate", "standard_charge_dollar": 14892.97 }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25585.96, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13188.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14947.6 }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 13188.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 23470.09 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13188.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 13188.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 26377.28, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "case rate", "standard_charge_dollar": 13188.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "case rate", "standard_charge_dollar": 25058.42, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ADRENAL PROCEDURES - SOI : 3", "code_information": [ { "code": "4013", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7056.97, "maximum": 7056.97, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 7056.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 7056.97 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 7056.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 7056.97 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7056.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 7056.97, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALA DELTA - RANDOM URINE", "code_information": [ { "code": "82135", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 135.2, "discounted_cash": 16, "minimum": 16.45, "maximum": 135.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.91, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 16.45 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 16.45 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.61, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 23.85, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 16.45 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 16.45 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.62, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.24, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.21, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.45 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.78, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.91, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.91, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.1, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.57, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.91, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.45 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 16.45 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.26, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ALLERGY IGEEACH", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 22.17, "discounted_cash": 5, "minimum": 2.1, "maximum": 293.4, "payers_information": [ { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.13, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.4, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 7.57, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.08, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.23, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.13, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.13, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.34, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.13, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 11.88, "10th_percentile": 9.75, "90th_percentile": 43.03, "count": "13" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.92, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ADRENAL PROCEDURES - SOI : 4", "code_information": [ { "code": "4014", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7056.97, "maximum": 7056.97, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 7056.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 7056.97 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 7056.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 7056.97 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7056.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 7056.97, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALLERGY IGGEACH - 86001 - 5081141", "code_information": [ { "code": "86001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 50, "discounted_cash": 7, "minimum": 2.7, "maximum": 50, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.17, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 7.82 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 7.82 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.08, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 11.34, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 7.82 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 7.82 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.61, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.33, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.82 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.98, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.17, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.17, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.48, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.17, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.82 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 11.88, "10th_percentile": 11.88, "90th_percentile": 22, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 7.82 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.86, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "AFP MATERNAL SERUM FOR OPEN SPINA BIFIDA", "code_information": [ { "code": "82105", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 89.6, "discounted_cash": 16, "minimum": 12.21, "maximum": 89.6, "payers_information": [ { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.53, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 16.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 16.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.19, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 24.32, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 16.77 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 16.77 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.18, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.87, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.64, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.77 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.11, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.53, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.53, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.45, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.2, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.53, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.77 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 16.77 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.86, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ALCOHOL & DRUG DEPENDENCE W REHAB OR REHABDETOX THERAPY - SOI : 4", "code_information": [ { "code": "7724", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 1087.3, "maximum": 1087.3, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 1087.3, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 1087.3 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 1087.3, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 1087.3 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1087.3, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 1087.3, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALBUMIN BODY FLUID", "code_information": [ { "code": "82042", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 26, "discounted_cash": 7, "minimum": 7.78, "maximum": 26, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.09, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 7.78 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 7.78 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 11.28, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 7.78 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 7.78 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.25, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.78 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.94, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.09, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.09, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.4, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.09, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.78 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 7.78 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "AFTERCARE WITHOUT CCMCC", "code_information": [ { "code": "950", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5155, "minimum": 5155.02, "maximum": 19117.9, "payers_information": [ { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 5155.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10310.04, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "case rate", "standard_charge_dollar": 5155.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "case rate", "standard_charge_dollar": 9794.54, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5155.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10000.74, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 5155.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 5155.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9279.04, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "case rate", "standard_charge_dollar": 7474.78, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "case rate", "standard_charge_dollar": 5155.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8969.73, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "case rate", "standard_charge_dollar": 6701.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10103.84, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "plan_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "methodology": "case rate", "standard_charge_dollar": 8248.03, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "case rate", "standard_charge_dollar": 6959.28, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "case rate", "standard_charge_dollar": 5258.12, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10000.74, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10000.74, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10310.04, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 5670.52, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10206.94, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Fully Insured", "methodology": "case rate", "standard_charge_dollar": 5211.74 }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Self Funded", "methodology": "case rate", "standard_charge_dollar": 5559.18 }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10000.74, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5155.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19117.9 }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 5155.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 8760.81 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5155.02, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ALCOHOL ABUSE & DEPENDENCE - SOI : 2", "code_information": [ { "code": "7752", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 2174.61, "maximum": 2174.61, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 2174.61, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 2174.61 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 2174.61, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 2174.61 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2174.61, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 2174.61, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC", "code_information": [ { "code": "896", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13672, "minimum": 11380.1, "maximum": 27345.36, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13672.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 26525, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 13672.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 13672.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24610.82, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "case rate", "standard_charge_dollar": 19825.39, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "case rate", "standard_charge_dollar": 13672.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23790.46, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "case rate", "standard_charge_dollar": 17774.51, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 26798.45, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "plan_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "methodology": "case rate", "standard_charge_dollar": 21876.29, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "case rate", "standard_charge_dollar": 18458.12, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "case rate", "standard_charge_dollar": 13946.15, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 26525, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 26525, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 27345.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 15039.97, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 27071.91, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Fully Insured", "methodology": "case rate", "standard_charge_dollar": 14489.41 }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Self Funded", "methodology": "case rate", "standard_charge_dollar": 15455.36 }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 26525, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13672.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11380.1 }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 13672.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 24356.36 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13672.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 13672.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 27345.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "case rate", "standard_charge_dollar": 13672.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "case rate", "standard_charge_dollar": 25978.09, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ALCOHOL & DRUG DEPENDENCE W REHAB OR REHABDETOX THERAPY - SOI : 2", "code_information": [ { "code": "7722", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 1087.3, "maximum": 1087.3, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 1087.3, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 1087.3 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 1087.3, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 1087.3 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1087.3, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 1087.3, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC", "code_information": [ { "code": "897", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7099, "minimum": 7099.58, "maximum": 14850, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7099.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13773.19, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 7099.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 7099.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12779.24, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "case rate", "standard_charge_dollar": 10294.39, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "case rate", "standard_charge_dollar": 7099.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12353.27, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "case rate", "standard_charge_dollar": 9229.45, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13915.18, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "plan_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "methodology": "case rate", "standard_charge_dollar": 11359.33, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "case rate", "standard_charge_dollar": 9584.43, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "case rate", "standard_charge_dollar": 7241.57, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13773.19, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13773.19, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14199.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7809.54, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14057.17, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Fully Insured", "methodology": "case rate", "standard_charge_dollar": 7329.81 }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Self Funded", "methodology": "case rate", "standard_charge_dollar": 7818.46 }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13773.19, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7099.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 7099.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 12321.24 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7099.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 7099.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14199.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "case rate", "standard_charge_dollar": 7099.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "case rate", "standard_charge_dollar": 13489.2, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY", "code_information": [ { "code": "895", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11160, "minimum": 7144.7, "maximum": 34200, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11161, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21652.3, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 11160.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 11161, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20089.76, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "case rate", "standard_charge_dollar": 16183.42, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "case rate", "standard_charge_dollar": 11161, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19420.11, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "case rate", "standard_charge_dollar": 14509.3, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21875.52, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "plan_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "methodology": "case rate", "standard_charge_dollar": 17857.57, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "case rate", "standard_charge_dollar": 15067.32, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "case rate", "standard_charge_dollar": 11384.22, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21652.3, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21652.3, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22321.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12277.1, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22098.74, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Fully Insured", "methodology": "case rate", "standard_charge_dollar": 11753.6 }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Self Funded", "methodology": "case rate", "standard_charge_dollar": 12537.16 }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21652.3, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11160.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7144.7 }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 11160.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 19757.53 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11161, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 11161, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22321.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "case rate", "standard_charge_dollar": 11161, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "case rate", "standard_charge_dollar": 21205.86, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ALCOHOL & DRUG DEPENDENCE W REHAB OR REHABDETOX THERAPY - SOI : 3", "code_information": [ { "code": "7723", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 1087.3, "maximum": 1087.3, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 1087.3, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 1087.3 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 1087.3, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 1087.3 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1087.3, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 1087.3, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALCOHOLIC LIVER DISEASE - SOI : 2", "code_information": [ { "code": "2802", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 2990.45, "maximum": 2990.45, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 2990.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 2990.45 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 2990.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 2990.45 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2990.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 2990.45, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALCOHOLIC LIVER DISEASE - SOI : 1", "code_information": [ { "code": "2801", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 2073.49, "maximum": 2073.49, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 2073.49, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 2073.49 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 2073.49, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 2073.49 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2073.49, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 2073.49, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALPHA FETOPROTEIN MATERNAL", "code_information": [ { "code": "82105", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 89.6, "discounted_cash": 16, "minimum": 12.21, "maximum": 89.6, "payers_information": [ { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.53, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 16.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 16.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.19, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 24.32, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 16.77 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 16.77 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.18, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.87, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.64, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.77 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.11, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.53, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.53, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.45, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.2, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.53, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.77 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 16.77 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.86, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ALCOHOL ABUSE & DEPENDENCE - SOI : 1", "code_information": [ { "code": "7751", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 1812.17, "maximum": 1812.17, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 1812.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 1812.17 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 1812.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 1812.17 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1812.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 1812.17, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALDOLASE", "code_information": [ { "code": "82085", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 20, "discounted_cash": 9, "minimum": 6, "maximum": 20, "payers_information": [ { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.84, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 9.71, "10th_percentile": 9.71, "90th_percentile": 9.71, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 9.71 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 9.71 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.48, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 14.08, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 9.71 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 9.71 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.9, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.03, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.11, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.71 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.9, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.84, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.84, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.42, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.23, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.84, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.71 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 8.8, "10th_percentile": 8.8, "90th_percentile": 8.8, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 9.71 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.42, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.45, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ALCOHOLIC LIVER DISEASE - SOI : 4", "code_information": [ { "code": "2804", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10333.75, "maximum": 10333.75, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 10333.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 10333.75 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 10333.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 10333.75 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 10333.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 10333.75, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALPHA-1-ANTITRYPSIN DEF.DNA", "code_information": [ { "code": "81332", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 488.7, "discounted_cash": 43, "minimum": 43.65, "maximum": 488.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 84.68, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 43.65 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 43.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 43.65 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 78.57, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 63.29, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 43.65 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 43.65 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 75.95, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 61.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 85.55, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 58.93, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 43.65 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.52, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 84.68, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 84.68, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 87.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 48.02, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 86.43, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 84.68, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 43.65 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 43.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 43.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 43.65 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 87.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 82.94, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ALDOSTERONE", "code_information": [ { "code": "82088", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 42.3, "discounted_cash": 40, "minimum": 12.69, "maximum": 100, "payers_information": [ { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 42.3, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 40.75 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 40.75 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 42.3, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 42.3, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 40.75 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 40.75 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 42.3, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 42.3, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 42.3, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.75 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.57, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 42.3, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 42.3, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 42.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.3, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 42.3, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 42.3, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.75 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 40.75 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 42.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 42.3, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ALKALINE PHOS CHARGE ONLY", "code_information": [ { "code": "84075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 25, "discounted_cash": 5, "minimum": 2.7, "maximum": 108, "payers_information": [ { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.05, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 5.18 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 5.18 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.32, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 7.51, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 5.18 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 5.18 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.01, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.15, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.99, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.18 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.28, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.05, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.05, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.7, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.26, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.05, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.18 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 5.18, "10th_percentile": 5.18, "90th_percentile": 5.18, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 5.18 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.84, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ALDOSTERONE 24 HR URINE", "code_information": [ { "code": "82088", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 100, "discounted_cash": 40, "minimum": 12.69, "maximum": 100, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 40.75 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 40.75 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 73.35, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 59.09, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 40.75 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 40.75 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 70.91, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 57.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 79.87, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 55.01, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.75 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.57, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 79.06, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 79.06, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 81.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.83, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 80.69, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 79.06, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.75 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 40.75 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 81.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 77.43, "additional_payer_notes": "190.00% of Medicare Rates" }, { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 79.06, "additional_payer_notes": "194.00% of Medicare Rates" } ] } ] }, { "description": "ALFALFA IGE", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 27, "discounted_cash": 5, "minimum": 2.1, "maximum": 293.4, "payers_information": [ { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.13, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.4, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 7.57, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.08, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.23, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.13, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.13, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.34, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.13, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 11.88, "10th_percentile": 9.75, "90th_percentile": 43.03, "count": "13" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.92, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ALLERGIC REACTIONS - SOI : 4", "code_information": [ { "code": "8114", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5436.52, "maximum": 5436.52, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 5436.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 5436.52 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 5436.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 5436.52 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5436.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 5436.52, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALKALINE PHOS", "code_information": [ { "code": "84075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 108, "discounted_cash": 5, "minimum": 2.7, "maximum": 108, "payers_information": [ { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.05, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 5.18 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 5.18 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.32, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 7.51, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 5.18 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 5.18 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.01, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.15, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.99, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.18 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.28, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.05, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.05, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.7, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.26, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.05, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.18 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 5.18, "10th_percentile": 5.18, "90th_percentile": 5.18, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 5.18 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.84, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ALTERNARIA TENUIS IGG", "code_information": [ { "code": "86001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9, "discounted_cash": 7, "minimum": 2.7, "maximum": 50, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 7.82 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 7.82 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 9, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 7.82 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 7.82 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.82 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.98, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.82 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 11.88, "10th_percentile": 11.88, "90th_percentile": 22, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 7.82 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ALLERGEN PROFILE REGION ALLERGEN ZON 8a", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 293.4, "discounted_cash": 5, "minimum": 2.1, "maximum": 293.4, "payers_information": [ { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.13, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.4, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 7.57, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.08, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.23, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.13, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.13, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.34, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.13, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 11.88, "10th_percentile": 9.75, "90th_percentile": 43.03, "count": "13" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.92, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ALUMINUM", "code_information": [ { "code": "82108", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 66.6, "discounted_cash": 25, "minimum": 19.98, "maximum": 66.6, "payers_information": [ { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 49.43, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 25.48 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 25.48 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 45.86, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 36.95, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 25.48 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 25.48 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 44.34, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.67, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 49.94, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.4, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.48 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.99, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 49.43, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 49.43, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 50.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.03, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 50.45, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 49.43, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.48 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 25.48 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 50.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 48.41, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ALK PHOSPHATASE, BONE SPECIFIC", "code_information": [ { "code": "84080", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 122.2, "discounted_cash": 14, "minimum": 7.5, "maximum": 122.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.67, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 14.78 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 14.78 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.6, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 21.43, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 14.78 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 14.78 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.72, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.97, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.95, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.78 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.67, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.67, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.26, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.67, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.78 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 14.78 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.08, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ALLERGEN RECOMBINANT CHARGE ONLY", "code_information": [ { "code": "86008", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 28, "discounted_cash": 17, "minimum": 4.5, "maximum": 82, "payers_information": [ { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 17.93 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.21, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.29, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.72, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 19.72, "10th_percentile": 19.72, "90th_percentile": 19.72, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "AMANTADINE", "code_information": [ { "code": "80375", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 236.25, "minimum": 18.54, "maximum": 1525, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 21.53 } ] } ] }, { "description": "ALLERGIC REACTIONS - SOI : 3", "code_information": [ { "code": "8113", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4349.22, "maximum": 4349.22, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 4349.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 4349.22 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 4349.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 4349.22 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4349.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 4349.22, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALPHA FETOPROTEIN TUMOR MARKER", "code_information": [ { "code": "82105", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40.7, "discounted_cash": 16, "minimum": 12.21, "maximum": 89.6, "payers_information": [ { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.53, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 16.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 16.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.19, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 24.32, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 16.77 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 16.77 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.18, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.87, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.64, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.77 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.11, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.53, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.53, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.45, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.2, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.53, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.77 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 16.77 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.86, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ALLERGIC REACTIONS - SOI : 1", "code_information": [ { "code": "8111", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 1449.74, "maximum": 1449.74, "payers_information": [ { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 1449.74, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 1449.74 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1449.74, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 1449.74, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 1449.74, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 1449.74 } ] } ] }, { "description": "AMEBIASIS ANTIBODIES", "code_information": [ { "code": "86753", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 105.9, "discounted_cash": 12, "minimum": 10.575, "maximum": 105.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.04, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 12.39 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 12.39 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.3, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 17.97, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 12.39 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 12.39 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.56, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.28, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.73, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.39 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.64, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.04, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.04, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.78, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.53, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.04, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.39 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 12.39 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.78, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.54, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ALLERGIC REACTIONS WITHOUT MCC", "code_information": [ { "code": "916", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5449, "minimum": 4287.79, "maximum": 10898.52, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5449.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10571.56, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 5449.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 5449.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9808.67, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "case rate", "standard_charge_dollar": 7901.43, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "case rate", "standard_charge_dollar": 5449.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9481.71, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "case rate", "standard_charge_dollar": 7084.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10680.55, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "plan_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "methodology": "case rate", "standard_charge_dollar": 8718.82, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "case rate", "standard_charge_dollar": 7356.5, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "case rate", "standard_charge_dollar": 5558.25, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10571.56, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10571.56, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10898.52, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 5994.19, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10789.53, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Fully Insured", "methodology": "case rate", "standard_charge_dollar": 5532.23 }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Self Funded", "methodology": "case rate", "standard_charge_dollar": 5901.04 }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10571.56, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5449.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4287.79 }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 5449.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 9299.55 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5449.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 5449.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10898.52, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "case rate", "standard_charge_dollar": 5449.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "case rate", "standard_charge_dollar": 10353.59, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ALPHA FETOPROTEIN WITH AFP L3%, SERUM", "code_information": [ { "code": "82105", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 61.1, "discounted_cash": 16, "minimum": 12.21, "maximum": 89.6, "payers_information": [ { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.53, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 16.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 16.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.19, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 24.32, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 16.77 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 16.77 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.18, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.87, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.64, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.77 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.11, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.53, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.53, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.45, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.2, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.53, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.77 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 16.77 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.86, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "AMG", "code_information": [ { "code": "83883", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 145.5, "discounted_cash": 13, "minimum": 13.6, "maximum": 145.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.38, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 13.6, "10th_percentile": 13.6, "90th_percentile": 13.6, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 13.6 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 13.6 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.48, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 19.72, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 13.6 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 13.6 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.66, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.66, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.36, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.6 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.38, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.38, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.96, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.93, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.38, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.6 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 13.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.84, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ALLERGY IGGEACH - 86001 - 5081123", "code_information": [ { "code": "86001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9, "discounted_cash": 7, "minimum": 2.7, "maximum": 50, "payers_information": [ { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.82 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 11.88, "10th_percentile": 11.88, "90th_percentile": 22, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 7.82 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 7.82 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 7.82 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 9, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 7.82 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 7.82 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.82 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.98, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "ALPHA SUBUNIT PITUITARY GLYCOPROTEIN H", "code_information": [ { "code": "83519", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 158.82, "discounted_cash": 18, "minimum": 4.5, "maximum": 1200, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.7, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 18.4, "10th_percentile": 18.4, "90th_percentile": 18.4, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 18.4 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 18.4 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.12, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 26.68, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 18.4 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 18.4 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.02, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.06, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.84, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.4 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.77, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.7, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.7, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.43, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.7, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.4 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 18.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.96, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ALMOND IGE", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 27, "discounted_cash": 5, "minimum": 2.1, "maximum": 293.4, "payers_information": [ { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.13, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.4, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 7.57, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.08, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.23, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.13, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.13, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.34, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.13, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 11.88, "10th_percentile": 9.75, "90th_percentile": 43.03, "count": "13" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.92, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "AMIKACIN TROUGH", "code_information": [ { "code": "80150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 26, "discounted_cash": 15, "minimum": 7.8, "maximum": 26, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 15.08 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 15.08 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 21.87, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 15.08 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 15.08 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.36, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.08 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.38, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.08 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 15.08 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ALLOGENEIC BONE MARROW TRANSPLANT", "code_information": [ { "code": "014", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 91979, "minimum": 91979.67, "maximum": 183959.34, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 91979.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 178440.56, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 91979.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 91979.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 165563.41, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "case rate", "standard_charge_dollar": 133370.52, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "case rate", "standard_charge_dollar": 91979.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 160044.63, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "case rate", "standard_charge_dollar": 119573.61, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 180280.15, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "plan_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "methodology": "case rate", "standard_charge_dollar": 147167.47, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "case rate", "standard_charge_dollar": 124172.55, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "case rate", "standard_charge_dollar": 93819.29, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 178440.56, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 178440.56, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 183959.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 101177.67, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 182119.75, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Fully Insured", "methodology": "case rate", "standard_charge_dollar": 99783.54 }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Self Funded", "methodology": "case rate", "standard_charge_dollar": 106435.69 }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 178440.56, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 91979.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 114017 }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 91979.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 167733.83 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 91979.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 91979.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 183959.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "case rate", "standard_charge_dollar": 91979.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "case rate", "standard_charge_dollar": 174761.37, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ALTEPLASE wDILU (ACTIVASE) VIAL: 100MG", "drug_information": { "unit": 100, "type": "ME" }, "code_information": [ { "code": "50242008527", "type": "NDC" }, { "code": "J2997", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 93, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 542.96, "10th_percentile": 542.96, "90th_percentile": 542.96, "count": "1 through 10" } ] } ] }, { "description": "AMINO ACIDS QUANT URINE", "code_information": [ { "code": "82139", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 156, "discounted_cash": 16, "minimum": 16.87, "maximum": 281, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.73, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 16.87 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 16.87 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.37, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 24.46, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 16.87 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 16.87 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.35, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.07, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.77, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.87 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.21, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.73, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.73, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.4, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.73, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.87 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 16.87 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.05, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ALPHA GALACTOSE 1,3 IGE SPECIFIC", "code_information": [ { "code": "86008", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 82, "discounted_cash": 17, "minimum": 4.5, "maximum": 82, "payers_information": [ { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.78, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 17.93 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.27, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.2, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.14, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.21, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.29, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.78, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.78, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.72, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.5, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.78, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 36.08, "10th_percentile": 36.08, "90th_percentile": 36.08, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.07, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ALTERNARIA TENUIS IGE", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 27, "discounted_cash": 5, "minimum": 2.1, "maximum": 293.4, "payers_information": [ { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.13, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.4, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 7.57, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.08, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.23, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.13, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.13, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.34, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.13, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 11.88, "10th_percentile": 9.75, "90th_percentile": 43.03, "count": "13" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.92, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "AMIODARONE - 80151 - 5080406", "code_information": [ { "code": "80151", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 24, "discounted_cash": 18, "minimum": 7.2, "maximum": 25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 18.64 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 18.64 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 24, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 18.64 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 18.64 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.64 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.01, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.5, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.64 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 18.64 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ALPHA GALACTOSIDASE A", "code_information": [ { "code": "82657", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 205.68, "discounted_cash": 22, "minimum": 22.17, "maximum": 415.41, "payers_information": [ { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 42.12, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.01, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 22.17, "10th_percentile": 22.17, "90th_percentile": 22.17, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 22.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 22.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 39.91, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 32.15, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 22.17 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 22.17 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 38.58, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.45, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.93, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.17 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.61, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.01, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.01, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 44.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.39, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.9, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.01, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.17 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 22.17 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 44.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "AMITRIPTYLINE - 80335 - 5079762", "code_information": [ { "code": "80335", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 31, "minimum": 5, "maximum": 74.2, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 5 } ] } ] }, { "description": "AMMONIA", "code_information": [ { "code": "82140", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 130, "discounted_cash": 14, "minimum": 14.57, "maximum": 130, "payers_information": [ { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.27, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 14.57 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 14.57 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.23, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 21.13, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 14.57 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 14.57 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.35, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.4, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.56, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.67, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.57 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.86, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.27, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.27, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.03, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.85, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.27, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.57 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 14.57 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.68, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ALPHA-2 MACROGLOBULINS", "code_information": [ { "code": "83883", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 58.45, "discounted_cash": 13, "minimum": 13.6, "maximum": 145.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.38, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 13.6, "10th_percentile": 13.6, "90th_percentile": 13.6, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 13.6 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 13.6 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.48, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 19.72, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 13.6 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 13.6 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.66, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.66, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.36, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.6 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.38, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.38, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.96, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.93, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.38, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.6 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 13.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.84, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "AMIKACIN", "code_information": [ { "code": "80150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 26, "discounted_cash": 15, "minimum": 7.8, "maximum": 26, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 15.08 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 15.08 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 21.87, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 15.08 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 15.08 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.36, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.08 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.38, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.08 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 15.08 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ALPHA1 ANTITRYPSIN PHENOTYPE", "code_information": [ { "code": "82104", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 121, "discounted_cash": 14, "minimum": 14.46, "maximum": 121, "payers_information": [ { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.05, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 14.46 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 14.46 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.03, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 20.97, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 14.46 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 14.46 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.16, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.34, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.52, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.46 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.75, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.05, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.05, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.91, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.63, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.05, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.46 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 14.46 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.47, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "AMINO ACID PROFILE, QN, PLASMA", "code_information": [ { "code": "82139", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 281, "discounted_cash": 16, "minimum": 16.87, "maximum": 281, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.73, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 16.87 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 16.87 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.37, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 24.46, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 16.87 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 16.87 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.35, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.07, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.77, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.87 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.21, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.73, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.73, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.4, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.73, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.87 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 16.87 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.05, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "AMPLIFIED PROBE CHARGE ONLY", "code_information": [ { "code": "87798", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 107.27, "discounted_cash": 35, "minimum": 18.3, "maximum": 1653.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 68.07, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 63.16, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 50.88, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 61.06, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 68.78, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 47.37, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.79, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 68.07, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 68.07, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 70.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 69.48, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 68.07, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 47.2, "10th_percentile": 47.2, "90th_percentile": 47.2, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 70.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 66.67, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "AMINO LEVULINIC ACID", "code_information": [ { "code": "82135", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 135.2, "discounted_cash": 16, "minimum": 16.45, "maximum": 135.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.91, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 16.45 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 16.45 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.61, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 23.85, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 16.45 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 16.45 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.62, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.24, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.21, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.45 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.78, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.91, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.91, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.1, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.57, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.91, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.45 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 16.45 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.26, "additional_payer_notes": "190.00% 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": 9366, "minimum": 8352.3, "maximum": 18733.18, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9366.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18171.18, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 9366.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 9366.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16859.86, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "case rate", "standard_charge_dollar": 13581.56, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "case rate", "standard_charge_dollar": 9366.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16297.87, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "case rate", "standard_charge_dollar": 12176.57, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18358.52, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "plan_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "methodology": "case rate", "standard_charge_dollar": 14986.54, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "case rate", "standard_charge_dollar": 12644.9, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "case rate", "standard_charge_dollar": 9553.92, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18171.18, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18171.18, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18733.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10303.25, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18545.85, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Fully Insured", "methodology": "case rate", "standard_charge_dollar": 9799.09 }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Self Funded", "methodology": "case rate", "standard_charge_dollar": 10452.36 }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18171.18, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9366.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8352.3 }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 9366.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 16472.05 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9366.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 9366.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18733.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "case rate", "standard_charge_dollar": 9366.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "case rate", "standard_charge_dollar": 17796.52, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ALTEPLASE wDILU (ACTIVASE)VIAL: 50MG", "drug_information": { "unit": 50, "type": "ME" }, "code_information": [ { "code": "50242004413", "type": "NDC" }, { "code": "J2997", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 93, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 542.96, "10th_percentile": 542.96, "90th_percentile": 542.96, "count": "1 through 10" } ] } ] }, { "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": 10923, "minimum": 10923.16, "maximum": 21846.32, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10923.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21190.93, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 10923.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 10923.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19661.69, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "case rate", "standard_charge_dollar": 15838.58, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "case rate", "standard_charge_dollar": 10923.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19006.3, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "case rate", "standard_charge_dollar": 14200.16, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21409.39, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "plan_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "methodology": "case rate", "standard_charge_dollar": 17477.06, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "case rate", "standard_charge_dollar": 14746.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "case rate", "standard_charge_dollar": 11141.66, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21190.93, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21190.93, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21846.32, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12015.52, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21627.86, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Fully Insured", "methodology": "case rate", "standard_charge_dollar": 11494.55 }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Self Funded", "methodology": "case rate", "standard_charge_dollar": 12260.84 }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21190.93, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10923.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16269.7 }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 10923.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 19322.07 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10923.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 10923.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21846.32, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "case rate", "standard_charge_dollar": 10923.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "case rate", "standard_charge_dollar": 20754, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION OF LOWER LIMB EXCEPT TOES - SOI : 1", "code_information": [ { "code": "3051", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4718.9, "maximum": 4718.9, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 4718.9, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 4718.9 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 4718.9, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 4718.9 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4718.9, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 4718.9, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AMIKACIN PEAK", "code_information": [ { "code": "80150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 26, "discounted_cash": 15, "minimum": 7.8, "maximum": 26, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 21.87, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 15.08 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 15.08 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.36, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.08 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.38, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.08 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 15.08 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 15.08 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 15.08 } ] } ] }, { "description": "AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC", "code_information": [ { "code": "474", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 33093, "minimum": 33093.9, "maximum": 66187.84, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 33093.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 64202.2, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 33093.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 33093.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 59569.06, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "case rate", "standard_charge_dollar": 47986.18, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "case rate", "standard_charge_dollar": 33093.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 57583.42, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "case rate", "standard_charge_dollar": 43022.07, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 64864.08, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "plan_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "methodology": "case rate", "standard_charge_dollar": 52950.27, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "case rate", "standard_charge_dollar": 44676.79, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "case rate", "standard_charge_dollar": 33755.78, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 64202.2, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 64202.2, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 66187.84, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 36403.29, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 65525.96, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Fully Insured", "methodology": "case rate", "standard_charge_dollar": 35643.56 }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Self Funded", "methodology": "case rate", "standard_charge_dollar": 38019.77 }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 64202.2, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 33093.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 55996.6 }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 33093.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 59916.01 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 33093.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 33093.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 66187.84, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "case rate", "standard_charge_dollar": 33093.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "case rate", "standard_charge_dollar": 62878.45, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION OF LOWER LIMB EXCEPT TOES - SOI : 4", "code_information": [ { "code": "3054", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11732.02, "maximum": 11732.02, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 11732.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 11732.02 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 11732.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 11732.02 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 11732.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 11732.02, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AMINOCAPROIC ACID(AMICAR)SDV5GM20ML", "drug_information": { "unit": 5, "type": "GR" }, "code_information": [ { "code": "409434673", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 5.16, "10th_percentile": 5.16, "90th_percentile": 5.16, "count": "1 through 10" } ] } ] }, { "description": "AMIODARONE - 80151 - 5003115", "code_information": [ { "code": "80151", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 25, "discounted_cash": 18, "minimum": 7.2, "maximum": 25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 18.64 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 18.64 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 25, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 18.64 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 18.64 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.64 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.01, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.5, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.64 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 18.64 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION OF LOWER LIMB EXCEPT TOES - SOI : 2", "code_information": [ { "code": "3052", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5882.68, "maximum": 5882.68, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 5882.68, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 5882.68 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 5882.68, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 5882.68 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5882.68, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 5882.68, "additional_payer_notes": "100% of State Medicaid 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": 26953, "minimum": 23834.8, "maximum": 53907.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 26953.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 52290.37, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 26953.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 26953.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 48516.84, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "case rate", "standard_charge_dollar": 39083.01, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "case rate", "standard_charge_dollar": 26953.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 46899.61, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "case rate", "standard_charge_dollar": 35039.94, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 52829.45, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "plan_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "methodology": "case rate", "standard_charge_dollar": 43126.08, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "case rate", "standard_charge_dollar": 36387.63, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "case rate", "standard_charge_dollar": 27492.88, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 52290.37, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 52290.37, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 53907.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 29649.18, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 53368.52, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Fully Insured", "methodology": "case rate", "standard_charge_dollar": 28955.57 }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Self Funded", "methodology": "case rate", "standard_charge_dollar": 30885.91 }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 52290.37, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 26953.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23834.8 }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 26953.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 48673.64 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 26953.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 26953.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 53907.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "case rate", "standard_charge_dollar": 26953.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "case rate", "standard_charge_dollar": 51212.22, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "AMIODARONE - 80299 - 5082041", "code_information": [ { "code": "80299", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 30, "discounted_cash": 18, "minimum": 7.2, "maximum": 850, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 18.64 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 27.03, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 18.64 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 18.64 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.16, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.64 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.01, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.5, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.64 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 18.64 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ANAL AND PERINEAL PROCEDURES- SOI : 2", "code_information": [ { "code": "2262", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4106.75, "maximum": 4106.75, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 4106.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 4106.75 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 4106.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 4106.75 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4106.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 4106.75, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AMYLASE 24HR URINE", "code_information": [ { "code": "82150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 37.2, "discounted_cash": 6, "minimum": 3.6, "maximum": 153.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 75, "median_amount": 45, "10th_percentile": 45, "90th_percentile": 45, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.57, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 42, "10th_percentile": 42, "90th_percentile": 42, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 6.48 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 6.48 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.66, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 9.4, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 6.48 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 6.48 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.28, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.7, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.75, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.48 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.57, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.57, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.13, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.83, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.57, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.48 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 26.4, "10th_percentile": 26.4, "90th_percentile": 26.4, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 6.48 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.31, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "AMITRIPTYLINE - 80335 - 5000583", "code_information": [ { "code": "80335", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 24, "minimum": 5, "maximum": 74.2, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 5 } ] } ] }, { "description": "ANAL AND PERINEAL PROCEDURES- SOI : 3", "code_information": [ { "code": "2263", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4537.32, "maximum": 4537.32, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 4537.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 4537.32 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 4537.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 4537.32 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4537.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 4537.32, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANA REFLEX CASADE", "code_information": [ { "code": "86038", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 100, "discounted_cash": 12, "minimum": 7.32, "maximum": 100, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 75, "median_amount": 18.3, "10th_percentile": 18.3, "90th_percentile": 21.15, "count": "1 through 10" }, { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.45, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 12.09, "10th_percentile": 12.09, "90th_percentile": 12.09, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 12.09 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 12.09 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.76, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 17.53, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 12.09 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 12.09 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.04, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.7, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.32, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.09 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.33, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.45, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.45, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.3, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.94, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.45, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.09 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 12.41, "10th_percentile": 10.73, "90th_percentile": 12.41, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 12.09 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.97, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "AMNIOINFUSION TRANS ABD INCL US GUIDANCE", "code_information": [ { "code": "59070", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 391, "discounted_cash": 320, "minimum": 117.3, "maximum": 391, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 320.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 391, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 391 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance Off Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 391 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance On Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 391 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 391 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "case rate", "standard_charge_dollar": 391 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 320.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 391 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 320.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 391, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 391, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 391 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 391 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 320.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 391, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 391, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 391, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 391, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 391 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.24, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 391, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 391, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 391, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 352.9, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 391, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 391, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 391 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 320.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 320.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 320.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 391 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 320.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 320.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 391, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 320.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 391, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ANAL AND STOMAL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "349", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7006, "minimum": 7006.59, "maximum": 14013.18, "payers_information": [ { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13873.05, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Fully Insured", "methodology": "case rate", "standard_charge_dollar": 7228.51 }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Self Funded", "methodology": "case rate", "standard_charge_dollar": 7710.41 }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13592.78, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7006.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7164.11 }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 7006.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 12150.96 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7006.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 7006.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14013.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "case rate", "standard_charge_dollar": 7006.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "case rate", "standard_charge_dollar": 13312.52, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7006.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13592.78, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 7006.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 7006.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12611.86, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "case rate", "standard_charge_dollar": 10159.56, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "case rate", "standard_charge_dollar": 7006.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12191.47, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "case rate", "standard_charge_dollar": 9108.57, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13732.92, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "plan_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "methodology": "case rate", "standard_charge_dollar": 11210.54, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "case rate", "standard_charge_dollar": 9458.9, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "case rate", "standard_charge_dollar": 7146.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13592.78, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13592.78, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14013.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7707.25, "additional_payer_notes": "110.00% of Medicare Rates" } ] } ] }, { "description": "ANAL AND PERINEAL PROCEDURES- SOI : 1", "code_information": [ { "code": "2261", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4106.75, "maximum": 4106.75, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 4106.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 4106.75 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 4106.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 4106.75 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4106.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 4106.75, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANALYSIS WITH PROGRAMMING", "code_information": [ { "code": "62368", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 726, "discounted_cash": 323, "minimum": 217.8, "maximum": 726, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 627.32, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 726 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance Off Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 726 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance On Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 726 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 726 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "case rate", "standard_charge_dollar": 726 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 323.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 726 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 582.05, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 468.87, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 726 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 726 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 562.65, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 452.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 633.79, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 436.54, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 726 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 329.83, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 627.32, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 627.32, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 646.72, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 355.7, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 640.25, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 627.32, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 726 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 323.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 323.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 726 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 646.72, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 614.38, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ANAPLASMA PHAGOCYTOPHILUM DNA PCR", "code_information": [ { "code": "87798", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 200, "discounted_cash": 35, "minimum": 18.3, "maximum": 1653.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 68.07, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 63.16, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 50.88, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 61.06, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 68.78, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 47.37, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.79, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 68.07, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 68.07, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 70.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 69.48, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 68.07, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 47.2, "10th_percentile": 47.2, "90th_percentile": 47.2, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 70.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 66.67, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ANATOMIC CONTOUR PLATES", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 3430.7, "10th_percentile": 777, "90th_percentile": 3658.2, "count": "1 through 10" } ] } ] }, { "description": "ANCHOR HELIX ADVANCED BR3SUT 5.5MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 3430.7, "10th_percentile": 777, "90th_percentile": 3658.2, "count": "1 through 10" } ] } ] }, { "description": "ANCH SUT 4.5MM REELX KNTLS", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 3430.7, "10th_percentile": 777, "90th_percentile": 3658.2, "count": "1 through 10" } ] } ] }, { "description": "AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC", "code_information": [ { "code": "475", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17717, "minimum": 17717.3, "maximum": 35434.62, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17717.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 34371.58, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 17717.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 17717.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 31891.16, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "case rate", "standard_charge_dollar": 25690.1, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "case rate", "standard_charge_dollar": 17717.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 30828.12, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "case rate", "standard_charge_dollar": 23032.49, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 34725.93, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "plan_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "methodology": "case rate", "standard_charge_dollar": 28347.7, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "case rate", "standard_charge_dollar": 23918.37, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "case rate", "standard_charge_dollar": 18071.65, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 34371.58, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 34371.58, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 35434.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 19489.03, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 35080.27, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Fully Insured", "methodology": "case rate", "standard_charge_dollar": 18894.93 }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Self Funded", "methodology": "case rate", "standard_charge_dollar": 20154.58 }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 34371.58, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17717.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20297.4 }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 17717.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 31761.94 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 17717.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 17717.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 35434.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "case rate", "standard_charge_dollar": 17717.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "case rate", "standard_charge_dollar": 33662.89, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ANCHOR 2.3MM ICONIX2 WITH INTELLIBRAID", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 3430.7, "10th_percentile": 777, "90th_percentile": 3658.2, "count": "1 through 10" } ] } ] }, { "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": 22098, "minimum": 20230.4, "maximum": 44197.74, "payers_information": [ { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "case rate", "standard_charge_dollar": 41987.85, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 22098.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 42871.81, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 22098.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 22098.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 39777.97, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "case rate", "standard_charge_dollar": 32043.36, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "case rate", "standard_charge_dollar": 22098.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 38452.03, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "case rate", "standard_charge_dollar": 28728.57, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 43313.79, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "plan_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "methodology": "case rate", "standard_charge_dollar": 35358.19, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "case rate", "standard_charge_dollar": 29833.47, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "case rate", "standard_charge_dollar": 22540.88, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 42871.81, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 42871.81, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 44197.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 24308.79, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 43755.76, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Fully Insured", "methodology": "case rate", "standard_charge_dollar": 23667.44 }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Self Funded", "methodology": "case rate", "standard_charge_dollar": 25245.25 }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 42871.81, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 22098.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20230.4 }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 22098.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 39784.43 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 22098.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 22098.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 44197.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "case rate", "standard_charge_dollar": 22098.9, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION OF LOWER LIMB EXCEPT TOES - SOI : 3", "code_information": [ { "code": "3053", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9292.83, "maximum": 9292.83, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 9292.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 9292.83 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 9292.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 9292.83 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9292.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 9292.83, "additional_payer_notes": "100% of State Medicaid 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": 37887, "minimum": 37887.1, "maximum": 75774.22, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 37887.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 73500.99, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 37887.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 37887.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 68196.8, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "case rate", "standard_charge_dollar": 54936.31, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "case rate", "standard_charge_dollar": 37887.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 65923.57, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "case rate", "standard_charge_dollar": 49253.23, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 74258.74, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "plan_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "methodology": "case rate", "standard_charge_dollar": 60619.38, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "case rate", "standard_charge_dollar": 51147.6, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "case rate", "standard_charge_dollar": 38644.84, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 73500.99, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 73500.99, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 75774.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 41675.81, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 75016.48, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Fully Insured", "methodology": "case rate", "standard_charge_dollar": 40864.43 }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Self Funded", "methodology": "case rate", "standard_charge_dollar": 43588.69 }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 73500.99, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 37887.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 38416.4 }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 37887.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 68692.17 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 37887.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 37887.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 75774.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "case rate", "standard_charge_dollar": 37887.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "case rate", "standard_charge_dollar": 71985.51, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "AMYLASE", "code_information": [ { "code": "82150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 60, "discounted_cash": 6, "minimum": 3.6, "maximum": 153.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 75, "median_amount": 45, "10th_percentile": 45, "90th_percentile": 45, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.57, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 42, "10th_percentile": 42, "90th_percentile": 42, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 6.48 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 6.48 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.66, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 9.4, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 6.48 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 6.48 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.28, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.7, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.75, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.48 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.57, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.57, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.13, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.83, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.57, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.48 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 26.4, "10th_percentile": 26.4, "90th_percentile": 26.4, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 6.48 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.31, "additional_payer_notes": "190.00% 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": 14627, "minimum": 14627, "maximum": 29254.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14627, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28376.48, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 14627.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 14627, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 26328.69, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "case rate", "standard_charge_dollar": 21209.22, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "case rate", "standard_charge_dollar": 14627, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25451.07, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "case rate", "standard_charge_dollar": 19015.1, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28669.02, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "plan_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "methodology": "case rate", "standard_charge_dollar": 23403.28, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "case rate", "standard_charge_dollar": 19746.52, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "case rate", "standard_charge_dollar": 14919.54, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28376.48, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28376.48, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 29254.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 16089.7, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28961.56, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Fully Insured", "methodology": "case rate", "standard_charge_dollar": 15528.93 }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Self Funded", "methodology": "case rate", "standard_charge_dollar": 16564.18 }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28376.48, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14627.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14756.3 }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 14627.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 26103.78 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14627, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 14627, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 29254.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "case rate", "standard_charge_dollar": 14627, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "case rate", "standard_charge_dollar": 27791.4, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ANA BY IFA 164947", "code_information": [ { "code": "86038", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 28.2, "discounted_cash": 12, "minimum": 7.32, "maximum": 100, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 75, "median_amount": 18.3, "10th_percentile": 18.3, "90th_percentile": 21.15, "count": "1 through 10" }, { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.45, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 12.09, "10th_percentile": 12.09, "90th_percentile": 12.09, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 12.09 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 12.09 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.76, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 17.53, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 12.09 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 12.09 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.04, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.7, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.32, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.09 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.33, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.45, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.45, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.3, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.94, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.45, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.09 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 12.41, "10th_percentile": 10.73, "90th_percentile": 12.41, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 12.09 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.97, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ANGINA PECTORIS & CORONARY ATHEROSCLEROSIS - SOI : 1", "code_information": [ { "code": "1981", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 1586.02, "maximum": 1586.02, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 1586.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 1586.02 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 1586.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 1586.02 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1586.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 1586.02, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANCHOR HELIX PEEK WORTHOCORD 4.5MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 3430.7, "10th_percentile": 777, "90th_percentile": 3658.2, "count": "1 through 10" } ] } ] }, { "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": 11181, "minimum": 11181.57, "maximum": 22363.14, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11181.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21692.25, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 11181.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 11181.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20126.83, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "case rate", "standard_charge_dollar": 16213.28, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "case rate", "standard_charge_dollar": 11181.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19455.93, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "case rate", "standard_charge_dollar": 14536.08, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21915.88, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "plan_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "methodology": "case rate", "standard_charge_dollar": 17890.51, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "case rate", "standard_charge_dollar": 15095.12, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "case rate", "standard_charge_dollar": 11405.23, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21692.25, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21692.25, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22363.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12299.76, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22139.51, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Fully Insured", "methodology": "case rate", "standard_charge_dollar": 11776.02 }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Self Funded", "methodology": "case rate", "standard_charge_dollar": 12561.07 }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21692.25, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11181.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13416.7 }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 11181.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 19795.21 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11181.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 11181.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22363.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "case rate", "standard_charge_dollar": 11181.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "case rate", "standard_charge_dollar": 21244.98, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ANA COMP CHARGE ONLY", "code_information": [ { "code": "83516", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15, "discounted_cash": 11, "minimum": 4.5, "maximum": 337.2, "payers_information": [ { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 11.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 11.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 11.53 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 11.53 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.53 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.76, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.53 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 6.6, "10th_percentile": 6.6, "90th_percentile": 44.88, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 11.53 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ANGINA PECTORIS & CORONARY ATHEROSCLEROSIS - SOI : 4", "code_information": [ { "code": "1984", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4434.39, "maximum": 4434.39, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 4434.39, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 4434.39 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 4434.39, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 4434.39 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4434.39, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 4434.39, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANCHOR PEG 52MMCROSSLINK GLEN GBL ADV", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 3430.7, "10th_percentile": 777, "90th_percentile": 3658.2, "count": "1 through 10" } ] } ] }, { "description": "Amputation of toe", "code_information": [ { "code": "28820", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7938, "discounted_cash": 3444, "minimum": 1728.792, "maximum": 7938, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3444.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6682.99, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 4887 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance Off Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 4251 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance On Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 3571 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 4251 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "case rate", "standard_charge_dollar": 4646 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 3444.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 1728.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3444.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6200.71, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 4995.02, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 1728.79 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 1728.79 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3444.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5994.02, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4822.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6751.89, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4650.53, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 1728.79 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3513.74, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6682.99, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6682.99, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6889.68, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3789.32, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6820.78, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6682.99, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1728.79 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3444.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3444.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3444.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 1728.79 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3444.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3444.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6889.68, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3444.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6545.2, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ANA REFLEX PANEL 164962", "code_information": [ { "code": "86038", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 24.4, "discounted_cash": 12, "minimum": 7.32, "maximum": 100, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 75, "median_amount": 18.3, "10th_percentile": 18.3, "90th_percentile": 21.15, "count": "1 through 10" }, { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.45, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 12.09, "10th_percentile": 12.09, "90th_percentile": 12.09, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 12.09 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 12.09 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.76, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 17.53, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 12.09 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 12.09 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.04, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.7, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.32, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.09 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.33, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.45, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.45, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.3, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.94, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.45, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.09 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 12.41, "10th_percentile": 10.73, "90th_percentile": 12.41, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 12.09 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.97, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ANGIO RENAL UNI WITH FLUSH 2ND ORDER - 36253 - 41036253", "code_information": [ { "code": "36253", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4173.26, "discounted_cash": 5858, "minimum": 1251.978, "maximum": 4173.26, "payers_information": [ { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4173.26, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4173.26, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 4173.26 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4173.26, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4173.26, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4173.26, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4173.26, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4173.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4173.26, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4173.26, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4173.26 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4173.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4173.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 4173.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 4173.26 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4173.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4173.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4173.26, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4173.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4173.26, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4173.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4173.26, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 4173.26 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance Off Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 4173.26 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance On Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 3756 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 4173.26 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "case rate", "standard_charge_dollar": 4173.26 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 4173.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 4173.26 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4173.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4173.26, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 4173.26, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 4173.26 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 4173.26 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4173.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4173.26, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4173.26, "additional_payer_notes": "140.00% of Medicare Rates" } ] } ] }, { "description": "ANCHOR PEG CROSSLINK GLENOID GLOBAL ADV", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 3430.7, "10th_percentile": 777, "90th_percentile": 3658.2, "count": "1 through 10" } ] } ] }, { "description": "AMYLASE BODY FLUID", "code_information": [ { "code": "82150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 36.7, "discounted_cash": 6, "minimum": 3.6, "maximum": 153.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 75, "median_amount": 45, "10th_percentile": 45, "90th_percentile": 45, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.57, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 42, "10th_percentile": 42, "90th_percentile": 42, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 6.48 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 6.48 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.66, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 9.4, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 6.48 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 6.48 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.28, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.7, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.75, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.48 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.57, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.57, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.13, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.83, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.57, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.48 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 26.4, "10th_percentile": 26.4, "90th_percentile": 26.4, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 6.48 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.31, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ANAL AND STOMAL PROCEDURES WITH CC", "code_information": [ { "code": "348", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10346, "minimum": 10346.88, "maximum": 20693.76, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10346.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20072.95, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 10346.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 10346.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18624.38, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "case rate", "standard_charge_dollar": 15002.98, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "case rate", "standard_charge_dollar": 10346.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18003.57, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "case rate", "standard_charge_dollar": 13450.97, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20279.88, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "plan_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "methodology": "case rate", "standard_charge_dollar": 16555.01, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "case rate", "standard_charge_dollar": 13968.29, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "case rate", "standard_charge_dollar": 10553.84, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20072.95, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20072.95, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20693.76, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11381.59, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20486.82, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Fully Insured", "methodology": "case rate", "standard_charge_dollar": 10866.85 }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Self Funded", "methodology": "case rate", "standard_charge_dollar": 11591.3 }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20072.95, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10346.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13044.9 }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 10346.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 18266.92 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10346.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 10346.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20693.76, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "case rate", "standard_charge_dollar": 10346.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "case rate", "standard_charge_dollar": 19659.07, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ANGIO RENAL UNI WITH FLUSH 2ND ORDER - 36254 - 41036254", "code_information": [ { "code": "36254", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4173.26, "discounted_cash": 3324, "minimum": 1251.978, "maximum": 4173.26, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3324.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4173.26, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 4173.26 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance Off Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 4173.26 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance On Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 3571 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 4173.26 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "case rate", "standard_charge_dollar": 4173.26 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 3324.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 4173.26 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3324.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4173.26, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 4173.26, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 4173.26 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 4173.26 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3324.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4173.26, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4173.26, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4173.26, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4173.26, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 4173.26 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3390.76, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4173.26, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4173.26, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4173.26, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3656.7, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4173.26, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4173.26, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4173.26 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3324.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3324.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3324.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 4173.26 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3324.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3324.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4173.26, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3324.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4173.26, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ANA IFA REFLEX TO 9-BIOMARKER PROFILE", "code_information": [ { "code": "86038", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 28.2, "discounted_cash": 12, "minimum": 7.32, "maximum": 100, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 12.09 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.97, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 75, "median_amount": 18.3, "10th_percentile": 18.3, "90th_percentile": 21.15, "count": "1 through 10" }, { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.45, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 12.09, "10th_percentile": 12.09, "90th_percentile": 12.09, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 12.09 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 12.09 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.76, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 17.53, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 12.09 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 12.09 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.04, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.7, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.32, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.09 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.33, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.45, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.45, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.3, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.94, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.45, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.09 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 12.41, "10th_percentile": 10.73, "90th_percentile": 12.41, "count": "1 through 10" } ] } ] }, { "description": "ANALYSIS OF PROGRAMMABLE PUMP", "code_information": [ { "code": "62367", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 726, "discounted_cash": 323, "minimum": 217.8, "maximum": 726, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 627.32, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 726 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance Off Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 726 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance On Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 726 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 726 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "case rate", "standard_charge_dollar": 726 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 323.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 726 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 582.05, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 468.87, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 726 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 726 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 562.65, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 452.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 633.79, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 436.54, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 726 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 329.83, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 627.32, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 627.32, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 646.72, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 355.7, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 640.25, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 627.32, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 726 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 323.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 323.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 726 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 646.72, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 614.38, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ANGIO SELECT EA ADD VESSEL S&I", "code_information": [ { "code": "75774", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1978.41, "minimum": 78.44, "maximum": 1978.41, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 218.99 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 218.99 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 218.99 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 218.99 }, { "payer_name": "Pathfinder Advisor", "plan_name": "Path Finder Advisor Commercial (OP Only) (05-01-2021 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 78.44 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 218.99 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 218.99 } ] } ] }, { "description": "ANAL AND PERINEAL PROCEDURES- SOI : 4", "code_information": [ { "code": "2264", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5477.84, "maximum": 5477.84, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 5477.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 5477.84 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 5477.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 5477.84 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5477.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 5477.84, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANCA", "code_information": [ { "code": "86037", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 174.35, "discounted_cash": 12, "minimum": 5.001, "maximum": 174.35, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.38, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.69, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 17.47, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.97, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.62, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.38, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.38, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.86, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.38, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 76.71, "10th_percentile": 76.71, "90th_percentile": 76.71, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.9, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ANGIO TRNL BRACHIOCEP TRUBRAN", "code_information": [ { "code": "36902", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13859.5, "discounted_cash": 5992, "minimum": 900, "maximum": 13859.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5992.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11624.91, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 4589 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance Off Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 3993 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance On Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 3354 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 3993 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "case rate", "standard_charge_dollar": 4358 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 5992.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 13051.74 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5992.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10786, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 8688.72, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 13051.74 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 13051.74 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5992.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10426.46, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8389.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11744.75, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8089.5, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 13051.74 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6112.06, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11624.91, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11624.91, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11984.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6591.44, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11864.6, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11624.91, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 13051.74 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5992.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5992.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5992.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 13051.74 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5992.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5992.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11984.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5992.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11385.22, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ANGINA PECTORIS & CORONARY ATHEROSCLEROSIS - SOI : 2", "code_information": [ { "code": "1982", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 2653.75, "maximum": 2653.75, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 2653.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 2653.75 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 2653.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 2653.75 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2653.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 2653.75, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANAL AND STOMAL PROCEDURES WITH MCC", "code_information": [ { "code": "347", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17869, "minimum": 17869, "maximum": 35738, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17869, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 34665.86, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 17869, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 17869, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 32164.2, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "case rate", "standard_charge_dollar": 25910.05, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "case rate", "standard_charge_dollar": 17869, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 31092.06, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "case rate", "standard_charge_dollar": 23229.7, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 35023.24, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "plan_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "methodology": "case rate", "standard_charge_dollar": 28590.4, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "case rate", "standard_charge_dollar": 24123.15, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "case rate", "standard_charge_dollar": 18226.38, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 34665.86, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 34665.86, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 35738, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 19655.9, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 35380.62, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Fully Insured", "methodology": "case rate", "standard_charge_dollar": 19060.16 }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Self Funded", "methodology": "case rate", "standard_charge_dollar": 20330.82 }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 34665.86, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17869, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 25502.5 }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 17869, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 32039.69 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 17869, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 17869, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 35738, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "case rate", "standard_charge_dollar": 17869, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "case rate", "standard_charge_dollar": 33951.1, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ANGIOTENSIN CONV ENZYME CSF", "code_information": [ { "code": "82164", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 100, "discounted_cash": 14, "minimum": 11.01, "maximum": 100, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.32, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 14.6 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 14.6 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.28, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 21.17, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 14.6 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 14.6 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.4, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.62, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.71, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.6 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.89, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.32, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.32, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.91, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.32, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.6 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 14.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.74, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ANCHOR ADJUSTABLE SINGLE INCISION SLING", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 3430.7, "10th_percentile": 777, "90th_percentile": 3658.2, "count": "1 through 10" } ] } ] }, { "description": "ANKLE 2 VWS BIL", "code_information": [ { "code": "73600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 639.67, "discounted_cash": 91, "minimum": 55.692, "maximum": 639.67, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 91.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 177.74, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 323.65, "10th_percentile": 323.65, "90th_percentile": 323.65, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 91.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 55.69 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 91.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 164.92, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 132.85, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 55.69 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 55.69 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 91.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 159.42, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 128.27, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 179.58, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 123.69, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 55.69 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 93.45, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 177.74, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Pathfinder Advisor", "plan_name": "Path Finder Advisor Commercial (OP Only) (05-01-2021 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 121.35 }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 177.74, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 183.24, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 181.41, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 177.74, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 55.69 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 91.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 91.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 91.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 55.69 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 91.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 91.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 183.24, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 91.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.08, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ANKLE 3 VWS RT", "code_information": [ { "code": "73610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 754.7, "discounted_cash": 91, "minimum": 68.289, "maximum": 754.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 75, "median_amount": 566.03, "10th_percentile": 566.03, "90th_percentile": 566.03, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 91.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 177.74, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 374.47, "10th_percentile": 68.29, "90th_percentile": 528.29, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 91.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 68.29 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 91.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 164.92, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 132.85, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 68.29 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 68.29 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 91.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 159.42, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 128.27, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 179.58, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 123.69, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 68.29 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 93.45, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 177.74, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Pathfinder Advisor", "plan_name": "Path Finder Advisor Commercial (OP Only) (05-01-2021 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 121.35 }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 177.74, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 183.24, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 181.41, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 177.74, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 68.29 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 91.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 91.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 91.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 235.38, "10th_percentile": 235.38, "90th_percentile": 235.38, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 68.29 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 91.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 91.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 183.24, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 91.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.08, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ANCHOR SACROILIAC IMPLANT 11X40MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 3430.7, "10th_percentile": 777, "90th_percentile": 3658.2, "count": "1 through 10" } ] } ] }, { "description": "ANKLE 3 VWS LT", "code_information": [ { "code": "73610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 534.96, "discounted_cash": 91, "minimum": 68.289, "maximum": 754.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 75, "median_amount": 566.03, "10th_percentile": 566.03, "90th_percentile": 566.03, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 91.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 177.74, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 374.47, "10th_percentile": 68.29, "90th_percentile": 528.29, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 91.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 68.29 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 91.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 164.92, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 132.85, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 68.29 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 68.29 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 91.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 159.42, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 128.27, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 179.58, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 123.69, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 68.29 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 93.45, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 177.74, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Pathfinder Advisor", "plan_name": "Path Finder Advisor Commercial (OP Only) (05-01-2021 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 121.35 }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 177.74, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 183.24, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 181.41, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 177.74, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 68.29 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 91.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 91.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 91.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 235.38, "10th_percentile": 235.38, "90th_percentile": 235.38, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 68.29 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 91.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 91.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 183.24, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 91.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.08, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "Anoscopy remove lesion", "code_information": [ { "code": "46610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1711.5, "discounted_cash": 2922, "minimum": 513.45, "maximum": 1711.5, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "case rate", "standard_charge_dollar": 1711.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 1711.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 1242.31 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1711.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1711.5, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 1711.5, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 1242.31 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 1242.31 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1711.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1711.5, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1711.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1711.5, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1711.5, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 1242.31 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1711.5, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1711.5, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1711.5, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1711.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1711.5, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1711.5, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1711.5, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1242.31 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1711.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1711.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1711.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 1242.31 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1711.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1711.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1711.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1711.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1711.5, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1711.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1711.5, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 1711.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance Off Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 1711.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance On Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 1711.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 1711.5 } ] } ] }, { "description": "ANTEPARTUM WITHOUT O.R. PROCEDURE- SOI : 1", "code_information": [ { "code": "5661", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 1800.21, "maximum": 1800.21, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 1800.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 1800.21 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 1800.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 1800.21 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1800.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 1800.21, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANTEROLATERAL DISTAL TIBIA 3.5MM LCP RGT", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 3430.7, "10th_percentile": 777, "90th_percentile": 3658.2, "count": "1 through 10" } ] } ] }, { "description": "ANTI-HMGCR AB", "code_information": [ { "code": "83520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 180, "discounted_cash": 17, "minimum": 6.9, "maximum": 850, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.5, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 17.27 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 17.27 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.09, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 25.04, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 17.27 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 17.27 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.05, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.85, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.31, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.27 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.62, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.5, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.5, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.19, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.5, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.27 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 78.56, "10th_percentile": 78.56, "90th_percentile": 78.56, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 17.27 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.81, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ANGINA PECTORIS", "code_information": [ { "code": "311", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5720, "minimum": 5720.63, "maximum": 11441.26, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5720.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11098.02, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 5720.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 5720.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10297.13, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "case rate", "standard_charge_dollar": 8294.91, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "case rate", "standard_charge_dollar": 5720.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9953.9, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "case rate", "standard_charge_dollar": 7436.82, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11212.43, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "plan_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "methodology": "case rate", "standard_charge_dollar": 9153.01, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "case rate", "standard_charge_dollar": 7722.85, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "case rate", "standard_charge_dollar": 5835.04, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11098.02, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11098.02, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11441.26, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6292.69, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11326.85, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Fully Insured", "methodology": "case rate", "standard_charge_dollar": 5827.81 }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Self Funded", "methodology": "case rate", "standard_charge_dollar": 6216.33 }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11098.02, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5720.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6408.87 }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 5720.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 9796.42 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5720.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 5720.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11441.26, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "case rate", "standard_charge_dollar": 5720.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "case rate", "standard_charge_dollar": 10869.2, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ANTI-68kD (hsp 70) ABS", "code_information": [ { "code": "84181", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 51.09, "discounted_cash": 17, "minimum": 15.327, "maximum": 51.09, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.04, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 17.03 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 17.03 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.65, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 24.69, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 17.03 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 17.03 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.63, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.84, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.38, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.99, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.03 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.37, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.04, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.04, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.73, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.72, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.04, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.03 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 17.03 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.36, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ANTI-HU ANTIBODIES", "code_information": [ { "code": "86256", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 21, "discounted_cash": 12, "minimum": 6.3, "maximum": 21, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 17.47, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.97, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ANGINA PECTORIS & CORONARY ATHEROSCLEROSIS - SOI : 3", "code_information": [ { "code": "1983", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 2653.75, "maximum": 2653.75, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 2653.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 2653.75 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 2653.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 2653.75 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2653.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 2653.75, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANDROSTENEDIONE", "code_information": [ { "code": "82157", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 100, "discounted_cash": 29, "minimum": 29.28, "maximum": 100, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 56.8, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 29.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 29.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52.7, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 42.46, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 29.28 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 29.28 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 50.95, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.99, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 57.39, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 39.53, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.28 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.87, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 56.8, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 56.8, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 58.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.21, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 57.97, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 56.8, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.28 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 29.28 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 58.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 55.63, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ANTI-CENTROMERE ANTIBODY", "code_information": [ { "code": "86235", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 61.1, "discounted_cash": 17, "minimum": 7.5, "maximum": 182.5, "payers_information": [ { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.78, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 127.75, "10th_percentile": 17.93, "90th_percentile": 127.75, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 17.93 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 17.93 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.27, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 17.93 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 17.93 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.2, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.14, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.21, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.93 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.29, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.78, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.78, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.72, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.5, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.78, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.93 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 35.2, "10th_percentile": 11, "90th_percentile": 80.3, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 17.93 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.07, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ANTI-MITOCHONDRIAL AB", "code_information": [ { "code": "86381", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 59.5, "discounted_cash": 25, "minimum": 17.85, "maximum": 59.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 49.37, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 25.45 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 25.45 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 45.81, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 36.9, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 25.45 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 25.45 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 44.28, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 49.88, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.36, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.45 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.96, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 49.37, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 49.37, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 50.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 50.39, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 49.37, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.45 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 25.45 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 50.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 48.36, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ANGIO BRACHIOCEPHALIC RIGHT", "code_information": [ { "code": "37246", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13859.5, "discounted_cash": 5992, "minimum": 2100, "maximum": 13859.5, "payers_information": [ { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5992.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11984.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5992.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11385.22, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5992.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11624.91, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 4589 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance Off Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 3993 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance On Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 3354 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 3993 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "case rate", "standard_charge_dollar": 4358 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 5992.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 13051.74 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5992.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10786, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 8688.72, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 13051.74 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 13051.74 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5992.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10426.46, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8389.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11744.75, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8089.5, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 13051.74 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6112.06, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11624.91, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11624.91, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11984.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6591.44, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11864.6, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11624.91, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 13051.74 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5992.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5992.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5992.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 13051.74 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5992.22, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANGIO BRACHIOCEPHALIC LEFT", "code_information": [ { "code": "37246", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13859.5, "discounted_cash": 5992, "minimum": 2100, "maximum": 13859.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5992.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11624.91, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 4589 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance Off Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 3993 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance On Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 3354 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 3993 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "case rate", "standard_charge_dollar": 4358 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 5992.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 13051.74 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5992.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10786, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 8688.72, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 13051.74 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 13051.74 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5992.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10426.46, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8389.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11744.75, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8089.5, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 13051.74 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6112.06, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11624.91, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11624.91, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11984.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6591.44, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11864.6, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11624.91, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 13051.74 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5992.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5992.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5992.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 13051.74 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5992.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5992.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11984.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5992.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11385.22, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ANTI-GOLIMUMAB AB CHARGE ONLY", "code_information": [ { "code": "82397", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 850, "discounted_cash": 14, "minimum": 13.5, "maximum": 850, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.39, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 14.12 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 14.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 14.12 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.42, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 20.47, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 14.12 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 14.12 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.57, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.68, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.06, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.12 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.4, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.39, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.39, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.24, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.53, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.96, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.39, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.12 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 14.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 14.12 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.24, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.83, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ANTI-N-METHYL-D-ASPARTATE RECEPTOR", "code_information": [ { "code": "86255", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 712.5, "discounted_cash": 12, "minimum": 6.3, "maximum": 712.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.38, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.69, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 17.47, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.97, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.62, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.38, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.38, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.86, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.38, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.9, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ANGIO EXTREMITY RIGHT S&I", "code_information": [ { "code": "75710", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6259.89, "discounted_cash": 3324, "minimum": 327.171, "maximum": 6259.89, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3324.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6259.89, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 3324.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 327.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3324.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5983.69, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 4820.19, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 327.17 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 327.17 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3324.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5784.23, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4653.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6259.89, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4487.76, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 327.17 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3390.76, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6259.89, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Pathfinder Advisor", "plan_name": "Path Finder Advisor Commercial (OP Only) (05-01-2021 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4292.49 }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6259.89, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6259.89, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3656.7, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6259.89, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6259.89, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 327.17 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3324.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3324.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3324.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 327.17 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3324.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3324.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6259.89, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3324.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6259.89, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ANKLE 2 VWS LT", "code_information": [ { "code": "73600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 462.35, "discounted_cash": 91, "minimum": 55.692, "maximum": 639.67, "payers_information": [ { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 177.74, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 183.24, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 181.41, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 177.74, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 55.69 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 91.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 91.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 91.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 55.69 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 91.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 91.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 183.24, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 91.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.08, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 91.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 177.74, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 323.65, "10th_percentile": 323.65, "90th_percentile": 323.65, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 91.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 55.69 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 91.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 164.92, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 132.85, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 55.69 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 55.69 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 91.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 159.42, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 128.27, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 179.58, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 123.69, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 55.69 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 93.45, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 177.74, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Pathfinder Advisor", "plan_name": "Path Finder Advisor Commercial (OP Only) (05-01-2021 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 121.35 } ] } ] }, { "description": "ANTI-PL-12AB", "code_information": [ { "code": "83516", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 150, "discounted_cash": 11, "minimum": 4.5, "maximum": 337.2, "payers_information": [ { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.37, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 11.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 11.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.75, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 11.53 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 11.53 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.06, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.6, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.57, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.53 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.76, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.37, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.37, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.83, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.37, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.53 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 6.6, "10th_percentile": 6.6, "90th_percentile": 44.88, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 11.53 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.91, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ANTI-RI ANTIBODIES", "code_information": [ { "code": "86256", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 21, "discounted_cash": 12, "minimum": 6.3, "maximum": 21, "payers_information": [ { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 17.47, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.97, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21, "additional_payer_notes": "190.00% of Medicare Rates" }, { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANGIO FISTULAGRAFT", "code_information": [ { "code": "36901", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 550, "discounted_cash": 1657, "minimum": 165, "maximum": 1800, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 550, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 550, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 550 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance Off Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 550 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance On Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 550 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 550 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "case rate", "standard_charge_dollar": 550 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 550, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 550 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 550, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 550, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 550, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 550 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 550 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 550, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 550, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 550, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 550, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 550, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 550 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 550, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 550, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 550, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 550, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 550, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 550, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 550, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 550 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 550, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 550, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 550, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 550 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 550, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 550, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 550, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 550, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 550, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ANKLE 3 VWS BIL", "code_information": [ { "code": "73610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 534.96, "discounted_cash": 91, "minimum": 68.289, "maximum": 754.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 75, "median_amount": 566.03, "10th_percentile": 566.03, "90th_percentile": 566.03, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 91.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 177.74, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 374.47, "10th_percentile": 68.29, "90th_percentile": 528.29, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 91.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 68.29 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 91.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 164.92, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 132.85, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 68.29 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 68.29 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 91.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 159.42, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 128.27, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 179.58, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 123.69, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 68.29 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 93.45, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 177.74, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Pathfinder Advisor", "plan_name": "Path Finder Advisor Commercial (OP Only) (05-01-2021 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 121.35 }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 177.74, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 183.24, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 181.41, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 177.74, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 68.29 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 91.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 91.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 91.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 235.38, "10th_percentile": 235.38, "90th_percentile": 235.38, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 68.29 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 91.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 91.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 183.24, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 91.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.08, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ANTI-U3 RNP ANTIBODY", "code_information": [ { "code": "86235", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 182.5, "discounted_cash": 17, "minimum": 7.5, "maximum": 182.5, "payers_information": [ { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.78, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 127.75, "10th_percentile": 17.93, "90th_percentile": 127.75, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 17.93 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 17.93 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.27, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 17.93 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 17.93 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.2, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.14, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.21, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.93 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.29, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.78, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.78, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.72, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.5, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.78, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.93 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 35.2, "10th_percentile": 11, "90th_percentile": 80.3, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 17.93 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.07, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ANTI-U1 RNP AB (RDL)", "code_information": [ { "code": "86235", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 182.5, "discounted_cash": 17, "minimum": 7.5, "maximum": 182.5, "payers_information": [ { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.78, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 127.75, "10th_percentile": 17.93, "90th_percentile": 127.75, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 17.93 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 17.93 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.27, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 17.93 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 17.93 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.2, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.14, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.21, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.93 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.29, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.78, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.78, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.72, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.5, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.78, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.93 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 35.2, "10th_percentile": 11, "90th_percentile": 80.3, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 17.93 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.07, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ANGIO-BRACHIAL RETROGRAD R S&I", "code_information": [ { "code": "75710", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6259.89, "discounted_cash": 3324, "minimum": 327.171, "maximum": 6259.89, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3324.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6259.89, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 3324.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 327.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3324.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5983.69, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 4820.19, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 327.17 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 327.17 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3324.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5784.23, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4653.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6259.89, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4487.76, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 327.17 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3390.76, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6259.89, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Pathfinder Advisor", "plan_name": "Path Finder Advisor Commercial (OP Only) (05-01-2021 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4292.49 }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6259.89, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6259.89, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3656.7, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6259.89, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6259.89, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 327.17 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3324.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3324.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3324.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 327.17 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3324.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3324.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6259.89, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3324.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6259.89, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ANOSCOPY WREMOVAL FB", "code_information": [ { "code": "46608", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2004, "discounted_cash": 979, "minimum": 601.2, "maximum": 2004, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 979.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1899.42, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 2004 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance Off Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 2004 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance On Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 1759 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 2004 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "case rate", "standard_charge_dollar": 2004 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 979.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 1242.31 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 979.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1762.34, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 1419.67, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 1242.31 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 1242.31 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 979.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1703.6, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1370.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1919, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1321.76, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 1242.31 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 998.66, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1899.42, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1899.42, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1958.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1076.99, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1938.58, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1899.42, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1242.31 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 979.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 979.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 979.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 1242.31 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 979.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 979.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1958.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 979.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1860.25, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ANTIBODY STAIN EA ADDITIONAL-TC", "code_information": [ { "code": "88341", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 100, "minimum": 30, "maximum": 100, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 44, "10th_percentile": 44, "90th_percentile": 176, "count": "1 through 10" } ] } ] }, { "description": "ANTIBODY ASPERGILLUS CHARGE", "code_information": [ { "code": "86606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 22, "discounted_cash": 15, "minimum": 6.6, "maximum": 22, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 15.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 15.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 21.82, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 15.05 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 15.05 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.32, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.05 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.35, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.05 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 15.05 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ANTIGEN CHARGE ONLY", "code_information": [ { "code": "86235", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 182.5, "discounted_cash": 17, "minimum": 7.5, "maximum": 182.5, "payers_information": [ { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.78, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 127.75, "10th_percentile": 17.93, "90th_percentile": 127.75, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 17.93 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 17.93 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.27, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 17.93 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 17.93 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.2, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.14, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.21, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.93 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.29, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.78, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.78, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.72, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.5, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.78, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.93 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 35.2, "10th_percentile": 11, "90th_percentile": 80.3, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 17.93 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.07, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "AP OF SKIN GRAFT 100SQ CM OR 1% BODY ARE", "code_information": [ { "code": "15273", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5309.18, "discounted_cash": 2172, "minimum": 1283.568, "maximum": 5309.18, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2172.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4214.2, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 4887 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance Off Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 4251 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance On Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 3571 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 4251 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "case rate", "standard_charge_dollar": 4646 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 2172.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 1283.57 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2172.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3910.09, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 3149.79, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 1283.57 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 1283.57 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2172.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3779.75, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3041.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4257.65, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2932.56, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 1283.57 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2215.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4214.2, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4214.2, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4344.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2389.5, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4301.09, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4214.2, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1283.57 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2172.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2172.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2172.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 1283.57 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2172.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2172.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4344.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2172.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4127.31, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ANTEPARTUM WITHOUT O.R. PROCEDURE- SOI : 2", "code_information": [ { "code": "5662", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 2387, "maximum": 2387, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 2387, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 2387 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 2387, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 2387 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2387, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 2387, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANTITHROMBIN ANTIGEN", "code_information": [ { "code": "85301", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 81.5, "discounted_cash": 10, "minimum": 10.81, "maximum": 81.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.97, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 10.81 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 10.81 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.46, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 15.67, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 10.81 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 10.81 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.81, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.19, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.81 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.03, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.97, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.97, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.89, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.4, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.97, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.81 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 10.81 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.54, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "AP OF SKIN GRAFT EACH ADDTL 25SQ CM", "code_information": [ { "code": "15276", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1858.5, "minimum": 285.87, "maximum": 1858.5, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 285.87 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 285.87 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 285.87 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 285.87 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 285.87 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 285.87 } ] } ] }, { "description": "ANGIOTENSIN CONV ENZYME SERUM", "code_information": [ { "code": "82164", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 36.7, "discounted_cash": 14, "minimum": 11.01, "maximum": 100, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.32, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 14.6 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 14.6 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.28, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 21.17, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 14.6 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 14.6 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.4, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.62, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.71, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.6 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.89, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.32, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.32, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.91, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.32, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.6 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 14.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.74, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ANTEPARTUM WITHOUT O.R. PROCEDURE- SOI : 3", "code_information": [ { "code": "5663", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 2729.86, "maximum": 2729.86, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 2729.86, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 2729.86 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 2729.86, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 2729.86 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2729.86, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 2729.86, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANTITHROMBIN III", "code_information": [ { "code": "85300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 72.5, "discounted_cash": 11, "minimum": 11.85, "maximum": 72.5, "payers_information": [ { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.99, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 11.85 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 11.85 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.33, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 17.18, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 11.85 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 11.85 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.62, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.23, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.85 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.99, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.99, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.7, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.04, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.46, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.99, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.85 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 11.85 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.7, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.52, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "AP OF SKIN GRAFT FIRST 25CM OR LESS", "code_information": [ { "code": "15271", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3270.53, "discounted_cash": 778, "minimum": 648.18, "maximum": 3270.53, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 778.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1509.53, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 3270.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance Off Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 3270.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance On Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 2781 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 3270.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "case rate", "standard_charge_dollar": 3270.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 778.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 648.18 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 778.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1400.6, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 1128.26, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 648.18 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 648.18 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 778.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1353.91, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1089.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1525.1, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1050.45, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 648.18 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 793.67, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1509.53, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1509.53, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1556.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 855.92, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1540.66, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1509.53, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 648.18 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 778.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 778.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 778.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 648.18 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 778.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 778.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1556.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 778.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1478.41, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ANKLE 2 VWS RT", "code_information": [ { "code": "73600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 462.35, "discounted_cash": 91, "minimum": 55.692, "maximum": 639.67, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 91.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 177.74, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 323.65, "10th_percentile": 323.65, "90th_percentile": 323.65, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 91.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 55.69 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 91.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 164.92, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 132.85, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 55.69 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 55.69 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 91.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 159.42, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 128.27, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 179.58, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 123.69, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 55.69 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 93.45, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 177.74, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Pathfinder Advisor", "plan_name": "Path Finder Advisor Commercial (OP Only) (05-01-2021 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 121.35 }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 177.74, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 183.24, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 181.41, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 177.74, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 55.69 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 91.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 91.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 91.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 55.69 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 91.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 91.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 183.24, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 91.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.08, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ANTI-MULLERIAN HORMONE (AMH), SERUM", "code_information": [ { "code": "83520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 228.05, "discounted_cash": 17, "minimum": 6.9, "maximum": 850, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.5, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 35, "10th_percentile": 35, "90th_percentile": 50.4, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 17.27 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 17.27 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.09, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 25.04, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 17.27 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 17.27 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.05, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.85, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.31, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.27 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.62, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.5, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.5, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.19, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.5, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.27 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 17.27 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.81, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "AORTA ABD & BILAT LOW EXTR S&I", "code_information": [ { "code": "75630", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6259.89, "discounted_cash": 3324, "minimum": 257.634, "maximum": 6259.89, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3324.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6259.89, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 3324.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 257.63 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3324.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5983.69, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 4820.19, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 257.63 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 257.63 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3324.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5784.23, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4653.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6259.89, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4487.76, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 257.63 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3390.76, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6259.89, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Pathfinder Advisor", "plan_name": "Path Finder Advisor Commercial (OP Only) (05-01-2021 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4292.49 }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6259.89, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6259.89, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3656.7, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6259.89, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6259.89, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 257.63 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3324.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3324.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3324.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 257.63 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3324.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3324.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6259.89, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3324.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6259.89, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS - SOI : 1", "code_information": [ { "code": "2331", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4332.55, "maximum": 4332.55, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 4332.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 4332.55 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 4332.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 4332.55 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4332.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 4332.55, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANOSCOPY", "code_information": [ { "code": "46600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 515.94, "discounted_cash": 140, "minimum": 140.07, "maximum": 515.94, "payers_information": [ { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 243.72, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 196.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 274.54, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 189.09, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 515.94 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 142.87, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 271.74, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 271.74, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 280.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.08, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 277.34, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 271.74, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 515.94 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 140.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 140.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 140.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 515.94 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 140.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 140.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 280.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 140.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 266.13, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 140.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 271.74, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 515.94 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance Off Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 515.94 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance On Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 515.94 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 515.94 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "case rate", "standard_charge_dollar": 515.94 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 140.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 515.94 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 140.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 252.13, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 203.1, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 515.94 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 515.94 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 140.07, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANTI-PHOSPHATIDYLETHANOLAMINE", "code_information": [ { "code": "83520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 23, "discounted_cash": 17, "minimum": 6.9, "maximum": 850, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 17.27 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 17.27 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 23, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 17.27 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 17.27 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.27 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.62, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.27 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 78.56, "10th_percentile": 78.56, "90th_percentile": 78.56, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 17.27 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23, "additional_payer_notes": "190.00% 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": 52798, "minimum": 14647.6, "maximum": 105597.46, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 52798.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 102429.54, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 52798.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 52798.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 95037.71, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "case rate", "standard_charge_dollar": 76558.16, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "case rate", "standard_charge_dollar": 52798.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 91869.79, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "case rate", "standard_charge_dollar": 68638.31, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 103485.51, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "plan_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "methodology": "case rate", "standard_charge_dollar": 84477.97, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "case rate", "standard_charge_dollar": 71278.29, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "case rate", "standard_charge_dollar": 53854.67, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 102429.54, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 102429.54, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 105597.46, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 58078.57, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 104541.49, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Fully Insured", "methodology": "case rate", "standard_charge_dollar": 57106.58 }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Self Funded", "methodology": "case rate", "standard_charge_dollar": 60913.64 }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 102429.54, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 52798.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14647.6 }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 52798.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 95994.85 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 52798.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 52798.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 105597.46, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "case rate", "standard_charge_dollar": 52798.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "case rate", "standard_charge_dollar": 100317.59, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS - SOI : 2", "code_information": [ { "code": "2332", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5999.02, "maximum": 5999.02, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 5999.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 5999.02 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 5999.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 5999.02 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5999.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 5999.02, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANTEPARTUM WITHOUT O.R. PROCEDURE- SOI : 4", "code_information": [ { "code": "5664", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4823.65, "maximum": 4823.65, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 4823.65, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 4823.65 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 4823.65, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 4823.65 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4823.65, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 4823.65, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANTI-PHOSPHATIDYLSERINE IGA", "code_information": [ { "code": "86148", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 28, "discounted_cash": 16, "minimum": 8.4, "maximum": 28, "payers_information": [ { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 16.07 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 16.07 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 23.3, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 16.07 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 16.07 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.96, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.69, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.07 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.39, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.07 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 16.07 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "AP OF SKIN GRAFT EACH ADDTL 100 SQ CM", "code_information": [ { "code": "15274", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2909, "minimum": 648.18, "maximum": 2909, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 648.18 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 648.18 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 648.18 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 648.18 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 648.18 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 648.18 } ] } ] }, { "description": "ANTERIOR ELEVATE", "code_information": [ { "code": "C1781", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 40, "median_amount": 3069.04, "10th_percentile": 3069.04, "90th_percentile": 3069.04, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 40, "median_amount": 1046.76, "10th_percentile": 1046.76, "90th_percentile": 1046.76, "count": "1 through 10" } ] } ] }, { "description": "ANTI-PMSCL-100 AB (RDL)", "code_information": [ { "code": "86235", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 182.5, "discounted_cash": 17, "minimum": 7.5, "maximum": 182.5, "payers_information": [ { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.78, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 127.75, "10th_percentile": 17.93, "90th_percentile": 127.75, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 17.93 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 17.93 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.27, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 17.93 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 17.93 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.2, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.14, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.21, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.93 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.29, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.78, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.78, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.72, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.5, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.78, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.93 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 35.2, "10th_percentile": 11, "90th_percentile": 80.3, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 17.93 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.07, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "AP WEDGED PRCT TIB PLATE SZ 3", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 3430.7, "10th_percentile": 777, "90th_percentile": 3658.2, "count": "1 through 10" } ] } ] }, { "description": "APPLICATION LONG ARM SPLINT (SHOULDER-HA", "code_information": [ { "code": "29105", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 660, "discounted_cash": 171, "minimum": 171.08, "maximum": 660, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 171.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 331.9, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 660 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance Off Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 660 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance On Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 660 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 660 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "case rate", "standard_charge_dollar": 660 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 171.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 381.15 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 171.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 307.94, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 248.07, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 381.15 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 381.15 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 171.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 297.68, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 239.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 335.32, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 230.96, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 381.15 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 174.5, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 331.9, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 331.9, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 342.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.19, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 338.74, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 331.9, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 381.15 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 171.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 171.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 171.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 1054.13, "10th_percentile": 1054.13, "90th_percentile": 1054.13, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 381.15 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 171.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 171.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 342.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 171.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 325.05, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ANTIBODY STAIN EA ADDITIONAL", "code_information": [ { "code": "88341", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 100, "minimum": 30, "maximum": 100, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 44, "10th_percentile": 44, "90th_percentile": 176, "count": "1 through 10" } ] } ] }, { "description": "APC RESISTANCE", "code_information": [ { "code": "85307", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 183.25, "discounted_cash": 15, "minimum": 15.32, "maximum": 183.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.72, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 15.32 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 15.32 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.58, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 22.21, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 15.32 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 15.32 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.66, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.03, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.68, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.32 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.63, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.72, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.72, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.85, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.33, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.72, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.32 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 15.32 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.11, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "APPLY MULTLAY COMPRS LWR LEG LEFT", "code_information": [ { "code": "29581", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 356.75, "discounted_cash": 171, "minimum": 107.025, "maximum": 356.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 171.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 331.9, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 356.75 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance Off Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 356.75 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance On Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 356.75 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 356.75 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "case rate", "standard_charge_dollar": 356.75 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 171.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 190.59 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 171.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 307.94, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 248.07, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 190.59 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 190.59 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 171.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 297.68, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 239.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 335.32, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 230.96, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 190.59 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 174.5, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 331.9, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 331.9, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 342.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.19, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 338.74, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 331.9, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 190.59 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 171.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 171.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 171.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 190.59 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 171.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 171.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 342.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 171.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 325.05, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ANTICHROMATIN ANTIBODIES", "code_information": [ { "code": "86235", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 46.8, "discounted_cash": 17, "minimum": 7.5, "maximum": 182.5, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.93 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 35.2, "10th_percentile": 11, "90th_percentile": 80.3, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 17.93 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.07, "additional_payer_notes": "190.00% of Medicare Rates" }, { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.78, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 127.75, "10th_percentile": 17.93, "90th_percentile": 127.75, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 17.93 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 17.93 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.27, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 17.93 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 17.93 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.2, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.14, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.21, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.93 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.29, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.78, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.78, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.72, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.5, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.78, "additional_payer_notes": "194.00% of Medicare Rates" } ] } ] }, { "description": "APOLIPOPROTEIN ASSESSMENT", "code_information": [ { "code": "82172", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 67.2, "discounted_cash": 21, "minimum": 18, "maximum": 67.2, "payers_information": [ { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 40.91, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 21.09, "10th_percentile": 21.09, "90th_percentile": 21.09, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 21.09 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 21.09 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 37.96, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 30.58, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 21.09 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 21.09 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.7, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.53, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 41.34, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.47, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.09 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.51, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 40.91, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 40.91, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 42.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.2, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 41.76, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 40.91, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.09 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 21.09 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 42.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 40.07, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ARBOVIRUS AB IV", "code_information": [ { "code": "86654", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18, "discounted_cash": 13, "minimum": 5.4, "maximum": 18, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 13.19 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 13.19 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 13.19 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 13.19 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.81, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.19 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.45, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.51, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.19 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 13.19 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ANTIFUNGAL SUSCEPTIBILITY", "code_information": [ { "code": "87186", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 250, "discounted_cash": 8, "minimum": 6, "maximum": 250, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 75, "median_amount": 60, "10th_percentile": 60, "90th_percentile": 60, "count": "1 through 10" }, { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.78, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 8.65, "10th_percentile": 8.65, "90th_percentile": 8.65, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 8.65 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 8.65 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.57, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 12.54, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 8.65 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 8.65 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.95, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.68, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.65 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.82, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.78, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.78, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.52, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.13, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.78, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.65 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 35.2, "10th_percentile": 35.2, "90th_percentile": 35.2, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 8.65 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.44, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS - SOI : 2", "code_information": [ { "code": "2342", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3666.03, "maximum": 3666.03, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 3666.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 3666.03 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 3666.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 3666.03 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3666.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 3666.03, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ARCH ONLY", "code_information": [ { "code": "36221", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6659.46, "discounted_cash": 3324, "minimum": 1997.838, "maximum": 6659.46, "payers_information": [ { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3324.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6316.11, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3324.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6449.08, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 4887 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance Off Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 4251 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance On Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 3571 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 4251 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "case rate", "standard_charge_dollar": 4646 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 3324.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 4315.74 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3324.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5983.69, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 4820.19, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 4315.74 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 4315.74 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3324.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5784.23, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4653.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6515.57, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4487.76, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 4315.74 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3390.76, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6449.08, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6449.08, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6648.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3656.7, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6582.05, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6449.08, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4315.74 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3324.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3324.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3324.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 4315.74 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3324.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3324.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6648.54, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "ANTI-INFLIXIMAB ANTIBODY", "code_information": [ { "code": "82397", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 400, "discounted_cash": 14, "minimum": 13.5, "maximum": 850, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.39, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 14.12 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 14.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 14.12 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.42, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 20.47, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 14.12 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 14.12 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.57, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.68, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.06, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.12 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.4, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.39, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.39, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.24, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.53, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.96, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.39, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.12 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 14.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 14.12 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.24, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.83, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ANTIHISTONE ANTIBODIES", "code_information": [ { "code": "86235", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 100, "discounted_cash": 17, "minimum": 7.5, "maximum": 182.5, "payers_information": [ { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.78, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 127.75, "10th_percentile": 17.93, "90th_percentile": 127.75, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 17.93 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 17.93 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.27, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 17.93 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 17.93 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.2, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.14, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.21, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.93 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.29, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.78, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.78, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.72, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.5, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.78, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.93 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 35.2, "10th_percentile": 11, "90th_percentile": 80.3, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 17.93 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.07, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS - SOI : 3", "code_information": [ { "code": "2343", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5529.67, "maximum": 5529.67, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 5529.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 5529.67 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 5529.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 5529.67 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5529.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 5529.67, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Artery-vein nonautograft", "code_information": [ { "code": "36830", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11143.91, "discounted_cash": 5858, "minimum": 2273.622, "maximum": 11143.91, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5858.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11143.91, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 5142 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance Off Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 4471 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance On Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 3756 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 4471 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "case rate", "standard_charge_dollar": 4886 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 5858.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 2273.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5858.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10545.17, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 8494.72, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 2273.62 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 2273.62 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5858.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10193.67, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8201.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11143.91, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7908.88, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 2273.62 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5975.6, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11143.91, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11143.91, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11143.91, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6444.27, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11143.91, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11143.91, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2273.62 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5858.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5858.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5858.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 2273.62 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5858.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5858.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11143.91, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5858.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11131.02, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ANTI-NUCLEAR ANTIBODY 164855", "code_information": [ { "code": "86038", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 24.4, "discounted_cash": 12, "minimum": 7.32, "maximum": 100, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 75, "median_amount": 18.3, "10th_percentile": 18.3, "90th_percentile": 21.15, "count": "1 through 10" }, { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.45, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 12.09, "10th_percentile": 12.09, "90th_percentile": 12.09, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 12.09 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 12.09 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.76, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 17.53, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 12.09 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 12.09 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.04, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.7, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.32, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.09 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.33, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.45, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.45, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.3, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.94, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.45, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.09 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 12.41, "10th_percentile": 10.73, "90th_percentile": 12.41, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 12.09 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.97, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ANTIMYELOPEROXIDASE (MPO) ABS", "code_information": [ { "code": "83520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 65.55, "discounted_cash": 17, "minimum": 6.9, "maximum": 850, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.5, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 35, "10th_percentile": 35, "90th_percentile": 50.4, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 17.27 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 17.27 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.09, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 25.04, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 17.27 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 17.27 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.05, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.85, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.31, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.27 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.62, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.5, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.5, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.19, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.5, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.27 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 17.27 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.81, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "APPENDIX PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "399", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9095, "minimum": 8550, "maximum": 18191.96, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9095.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17646.2, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 9095.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 9095.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16372.76, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "case rate", "standard_charge_dollar": 13189.17, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "case rate", "standard_charge_dollar": 9095.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15827.01, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "case rate", "standard_charge_dollar": 11824.77, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17828.12, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "plan_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "methodology": "case rate", "standard_charge_dollar": 14553.57, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "case rate", "standard_charge_dollar": 12279.57, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "case rate", "standard_charge_dollar": 9277.9, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17646.2, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17646.2, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18191.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10005.58, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18010.04, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Fully Insured", "methodology": "case rate", "standard_charge_dollar": 9504.34 }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Self Funded", "methodology": "case rate", "standard_charge_dollar": 10137.96 }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17646.2, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9095.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16329.9 }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 9095.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 15976.58 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9095.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 9095.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18191.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "case rate", "standard_charge_dollar": 9095.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "case rate", "standard_charge_dollar": 17282.36, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ARTHRO HIP INJECT PROCED", "code_information": [ { "code": "27093", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2010, "minimum": 285.87, "maximum": 2010, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 285.87 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 285.87 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 285.87 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 285.87 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 285.87 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 285.87 } ] } ] }, { "description": "ANTI-PHOSPHATIDYLSERINE IGG", "code_information": [ { "code": "86148", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 28, "discounted_cash": 16, "minimum": 8.4, "maximum": 28, "payers_information": [ { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 16.07 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 16.07 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 23.3, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 16.07 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 16.07 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.96, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.69, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.07 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.39, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.07 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 16.07 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ANTIPANCREATIC ISLET CELLS", "code_information": [ { "code": "86341", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 89.6, "discounted_cash": 23, "minimum": 23.57, "maximum": 252.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 45.73, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 23.57, "10th_percentile": 23.57, "90th_percentile": 23.57, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 23.57 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 23.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 23.57 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 42.43, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 34.18, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 23.57 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 23.57 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 41.01, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.82, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.57 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.04, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 45.73, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 45.73, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 47.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.93, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 46.67, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 45.73, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.57 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 23.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 23.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 23.57 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 47.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 44.78, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "APPL OF LOW COST SKIN SUB >= 100SQ CM", "code_information": [ { "code": "C5273", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4243.01, "discounted_cash": 1885, "minimum": 1272.903, "maximum": 4243.01, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1885.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1885.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1885.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1885.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1885.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3770.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1885.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3581.56, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1885.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3656.96, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 3807 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance Off Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 3311 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance On Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 2781 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 3311 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "case rate", "standard_charge_dollar": 3617 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 1885.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1885.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3393.05, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 2733.29, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1885.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3279.95, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2639.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3694.66, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2544.79, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1922.73, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3656.96, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3656.96, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3770.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2073.53, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3732.36, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3656.96, "additional_payer_notes": "194.00% of Medicare Rates" } ] } ] }, { "description": "ARTHROCENTISIS SMALL JOINT OR BURSA", "code_information": [ { "code": "20600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 364.86, "discounted_cash": 323, "minimum": 109.458, "maximum": 647, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 364.86, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 364.86 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance Off Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 364.86 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance On Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 364.86 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 364.86 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "case rate", "standard_charge_dollar": 364.86 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 285.87 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 364.86, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 364.86, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 285.87 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 285.87 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 364.86, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 364.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 364.86, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 364.86, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 285.87 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 329.62, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 364.86, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 364.86, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 364.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 355.48, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 364.86, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 364.86, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 285.87 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 285.87 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 364.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 364.86, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ANTI-PHOSPHATIDYLSERINE IGM", "code_information": [ { "code": "86148", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 28, "discounted_cash": 16, "minimum": 8.4, "maximum": 28, "payers_information": [ { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 16.07 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 16.07 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 23.3, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 16.07 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 16.07 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.96, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.69, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.07 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.39, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.07 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 16.07 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ANTIPROTEINASE 3 (PR-3) ABS", "code_information": [ { "code": "83516", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 65.55, "discounted_cash": 11, "minimum": 4.5, "maximum": 337.2, "payers_information": [ { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.37, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 11.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 11.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.75, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 11.53 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 11.53 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.06, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.6, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.57, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.53 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.76, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.37, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.37, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.83, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.37, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.53 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 6.6, "10th_percentile": 6.6, "90th_percentile": 44.88, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 11.53 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.91, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ARTHROGRAM HIP LT", "code_information": [ { "code": "73525", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1758.55, "discounted_cash": 367, "minimum": 204.477, "maximum": 1758.55, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 367.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 712.56, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 367.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 204.48 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 367.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 661.14, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 532.59, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 204.48 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 204.48 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 367.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 639.1, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 514.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 719.91, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 495.86, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 204.48 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 374.65, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 712.56, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Pathfinder Advisor", "plan_name": "Path Finder Advisor Commercial (OP Only) (05-01-2021 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 552.18 }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 712.56, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 734.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 404.03, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 727.25, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 712.56, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 204.48 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 367.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 367.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 367.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 204.48 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 367.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 367.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 734.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 367.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 697.87, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ANTI-SARS COV2", "code_information": [ { "code": "86328", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 90.45, "discounted_cash": 45, "minimum": 27.135, "maximum": 90.45, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 45.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 87.84, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 45.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 45.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 45.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 45.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 81.5, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 65.66, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 45.28 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 45.28 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 45.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 78.79, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 63.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 88.75, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 61.13, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 45.28 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.19, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 87.84, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 87.84, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 90.45, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.81, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 89.65, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 87.84, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 45.28 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 45.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 45.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 45.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 45.28 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 45.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 45.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 90.45, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 45.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 86.03, "additional_payer_notes": "190.00% 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": 32562, "minimum": 6658.36, "maximum": 65125.24, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 32562.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 63171.48, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 32562.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 32562.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 58612.72, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "case rate", "standard_charge_dollar": 47215.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "case rate", "standard_charge_dollar": 32562.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 56658.96, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "case rate", "standard_charge_dollar": 42331.38, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 63822.74, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "plan_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "methodology": "case rate", "standard_charge_dollar": 52100.19, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "case rate", "standard_charge_dollar": 43959.54, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "case rate", "standard_charge_dollar": 33213.85, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 63171.48, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 63171.48, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 65125.24, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 35818.86, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 64473.99, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Fully Insured", "methodology": "case rate", "standard_charge_dollar": 35064.85 }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Self Funded", "methodology": "case rate", "standard_charge_dollar": 37402.48 }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 63171.48, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 32562.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6658.36 }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 32562.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 58943.2 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 32562.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 32562.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 65125.24, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "case rate", "standard_charge_dollar": 32562.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "case rate", "standard_charge_dollar": 61868.98, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ARTHROGRAM SHOULDER RT", "code_information": [ { "code": "73040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1758.55, "discounted_cash": 367, "minimum": 213.174, "maximum": 1758.55, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 367.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 712.56, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 367.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 213.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 367.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 661.14, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 532.59, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 213.17 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 213.17 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 367.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 639.1, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 514.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 719.91, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 495.86, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 213.17 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 374.65, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 712.56, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Pathfinder Advisor", "plan_name": "Path Finder Advisor Commercial (OP Only) (05-01-2021 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 552.18 }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 712.56, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 734.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 404.03, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 727.25, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 712.56, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 213.17 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 367.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 367.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 367.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 213.17 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 367.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 367.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 734.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 367.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 697.87, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ANTI-SMOOTH MUSCLE", "code_information": [ { "code": "86015", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 52.9, "discounted_cash": 12, "minimum": 12.05, "maximum": 52.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.38, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.69, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 17.47, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.97, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.62, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.38, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.38, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.86, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.38, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.9, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "AORTIC ROOT ANGIO", "code_information": [ { "code": "93567", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2415.82, "minimum": 724.746, "maximum": 2415.82, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 1854.49 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 1854.49 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 1854.49 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1854.49 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1854.49 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 1854.49 } ] } ] }, { "description": "APPL UNIPLN UNI EXT FIXJ SYS", "code_information": [ { "code": "20690", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4278.66, "discounted_cash": 7639, "minimum": 1283.598, "maximum": 4278.66, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 1728.79 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4278.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4278.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4278.66, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4278.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4278.66, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4278.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4278.66, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 4278.66 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance Off Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 4278.66 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance On Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 4263 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 4278.66 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "case rate", "standard_charge_dollar": 4278.66 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 4278.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 1728.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4278.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4278.66, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 4278.66, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 1728.79 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 1728.79 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4278.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4278.66, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4278.66, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4278.66, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4278.66, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 1728.79 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4278.66, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4278.66, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4278.66, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4278.66, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4278.66, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4278.66, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4278.66, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1728.79 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4278.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4278.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 4278.66, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANTI-STREPTOLYSIN O", "code_information": [ { "code": "86060", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 36.7, "discounted_cash": 7, "minimum": 7.3, "maximum": 36.7, "payers_information": [ { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.16, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 7.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 7.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.14, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 10.59, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 7.3 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 7.3 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.7, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.31, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.86, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.3 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.45, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.16, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.16, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.03, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.16, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.3 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 16.15, "10th_percentile": 16.15, "90th_percentile": 16.15, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 7.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "AP OF SKIN GRAFT EACH ADDTL 100SQ CM", "code_information": [ { "code": "15278", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2776.95, "minimum": 648.18, "maximum": 2776.95, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 648.18 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 648.18 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 648.18 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 648.18 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 648.18 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 648.18 } ] } ] }, { "description": "APPLICATION OF SKIN SUBST GRFT >100SQ CM", "code_information": [ { "code": "15275", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3580.62, "discounted_cash": 778, "minimum": 648.18, "maximum": 3580.62, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 778.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1509.53, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 3580.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance Off Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 3311 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance On Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 2781 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 3311 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "case rate", "standard_charge_dollar": 3580.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 778.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 648.18 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 778.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1400.6, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 1128.26, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 648.18 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 648.18 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 778.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1353.91, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1089.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1525.1, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1050.45, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 648.18 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 793.67, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1509.53, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1509.53, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1556.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 855.92, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1540.66, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1509.53, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 648.18 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 778.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 778.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 778.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 648.18 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 778.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 778.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1556.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 778.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1478.41, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ASPERGILLUS IGG", "code_information": [ { "code": "86001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9, "discounted_cash": 7, "minimum": 2.7, "maximum": 50, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 7.82 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 7.82 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 9, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 7.82 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 7.82 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.82 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.98, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.82 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 11.88, "10th_percentile": 11.88, "90th_percentile": 22, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 7.82 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ANTIADRENAL ANTIBODIES, QUANTITATIVE", "code_information": [ { "code": "86255", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 73.3, "discounted_cash": 12, "minimum": 6.3, "maximum": 712.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.38, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.69, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 17.47, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.97, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.62, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.38, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.38, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.86, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.38, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.9, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "APPLICATION SHORT ARM SPLINT (FOREARM-H)", "code_information": [ { "code": "29125", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 530, "discounted_cash": 140, "minimum": 140.07, "maximum": 530, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 140.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 271.74, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 530 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance Off Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 530 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance On Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 530 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 530 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "case rate", "standard_charge_dollar": 530 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 140.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 381.15 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 140.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 252.13, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 203.1, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 381.15 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 381.15 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 140.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 243.72, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 196.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 274.54, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 189.09, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 381.15 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 142.87, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 271.74, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 271.74, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 280.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.08, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 277.34, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 271.74, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 381.15 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 140.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 140.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 140.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 233.2, "10th_percentile": 233.2, "90th_percentile": 955.69, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 381.15 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 140.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 140.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 280.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 140.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 266.13, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ASPIRATEINJ GANGLION CYST", "code_information": [ { "code": "20612", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4903.5, "discounted_cash": 323, "minimum": 285.87, "maximum": 4903.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 626.93, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 2406 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance Off Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 2094 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance On Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 1759 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 2094 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "case rate", "standard_charge_dollar": 2287 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 285.87 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 581.69, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 468.58, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 285.87 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 285.87 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 562.3, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 452.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 633.39, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 436.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 285.87 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 329.62, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 626.93, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 626.93, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 646.32, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 355.48, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 639.86, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 626.93, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 285.87 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 285.87 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 646.32, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 614, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ANTIBODY CHARGE", "code_information": [ { "code": "86658", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 75, "discounted_cash": 13, "minimum": 5.4, "maximum": 75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.28, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 13.03 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 13.03 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.45, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 18.89, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 13.03 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 13.03 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.67, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.54, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.59, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.03 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.29, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.28, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.28, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.33, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.8, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.28, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.03 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 13.03 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.76, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "APOLIPOPROTEIN A-1", "code_information": [ { "code": "82172", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 60, "discounted_cash": 21, "minimum": 18, "maximum": 67.2, "payers_information": [ { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 40.91, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 21.09, "10th_percentile": 21.09, "90th_percentile": 21.09, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 21.09 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 21.09 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 37.96, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 30.58, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 21.09 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 21.09 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.7, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.53, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 41.34, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.47, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.09 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.51, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 40.91, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 40.91, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 42.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.2, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 41.76, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 40.91, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.09 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 21.09 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 42.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 40.07, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "APPLICATION SHORT LEG CAST BELOW KNEE", "code_information": [ { "code": "29405", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1231.9, "discounted_cash": 294, "minimum": 194.838, "maximum": 1231.9, "payers_information": [ { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 588.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.91, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 583.03, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 571.25, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 381.15 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 294.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 294.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 294.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 381.15 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 294.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 294.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 588.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 294.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 559.47, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 294.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 571.25, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 1231.9 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance Off Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 1231.9 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance On Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 1231.9 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 1231.9 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "case rate", "standard_charge_dollar": 1231.9 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 294.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 381.15 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 294.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 530.03, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 426.97, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 381.15 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 381.15 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 294.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 512.36, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 412.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 577.14, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 397.52, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 381.15 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300.35, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 571.25, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 571.25, "additional_payer_notes": "194.00% of Medicare Rates" } ] } ] }, { "description": "ASSAY OF BARBITURATES", "code_information": [ { "code": "80345", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 20, "minimum": 6, "maximum": 48.2, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 10.9 } ] } ] }, { "description": "ANTIBODY IDENTIFICATION; PLATETET AB", "code_information": [ { "code": "86022", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 37.5, "discounted_cash": 18, "minimum": 11.25, "maximum": 206.05, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.64, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 18.37 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 18.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 18.37 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.07, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 26.64, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 18.37 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 18.37 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.96, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.01, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.8, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.37 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.74, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.64, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.64, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.21, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.37, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.64, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.37 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 18.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 18.37 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.9, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "APOLIPOPROTEIN B", "code_information": [ { "code": "82172", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 67.2, "discounted_cash": 21, "minimum": 18, "maximum": 67.2, "payers_information": [ { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 40.91, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 21.09, "10th_percentile": 21.09, "90th_percentile": 21.09, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 21.09 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 21.09 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 37.96, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 30.58, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 21.09 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 21.09 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.7, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.53, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 41.34, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.47, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.09 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.51, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 40.91, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 40.91, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 42.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.2, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 41.76, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 40.91, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.09 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 21.09 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 42.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 40.07, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "APPLICATION SHORT LEG SPLINT (CALF-FOOT)", "code_information": [ { "code": "29515", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 596.2, "discounted_cash": 171, "minimum": 171.08, "maximum": 596.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 171.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 331.9, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 596.2 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance Off Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 596.2 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance On Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 596.2 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 596.2 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "case rate", "standard_charge_dollar": 596.2 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 171.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 381.15 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 171.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 307.94, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 248.07, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 381.15 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 381.15 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 171.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 297.68, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 239.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 335.32, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 230.96, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 381.15 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 174.5, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 331.9, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 331.9, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 342.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.19, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 338.74, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 331.9, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 381.15 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 171.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 171.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 171.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 262.33, "10th_percentile": 262.33, "90th_percentile": 1164.26, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 381.15 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 171.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 171.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 342.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 171.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 325.05, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ASSAY SERUM CHOLINESTERASE", "code_information": [ { "code": "82480", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14, "discounted_cash": 7, "minimum": 4.2, "maximum": 15, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 7.87 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 7.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 7.87 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 11.41, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 7.87 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 7.87 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.69, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.62, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.87 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.03, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.66, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.87 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 7.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 7.87 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ANTIBODY STAIN EACH ADDITIONAL", "code_information": [ { "code": "88350", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 180, "minimum": 54, "maximum": 180, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 79.04 } ] } ] }, { "description": "APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS - SOI : 3", "code_information": [ { "code": "2333", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5999.02, "maximum": 5999.02, "payers_information": [ { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 5999.02 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5999.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 5999.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 5999.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 5999.02 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 5999.02, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ARSENIC", "code_information": [ { "code": "82175", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 153, "discounted_cash": 18, "minimum": 18.97, "maximum": 194.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.8, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 18.97 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 18.97 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.15, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 27.51, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 18.97 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 18.97 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.01, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.56, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 37.18, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.61, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.97 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.8, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.8, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 37.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 37.56, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.8, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.97 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 18.97 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 37.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.04, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ASTHMA - SOI : 2", "code_information": [ { "code": "1412", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 2466.37, "maximum": 2466.37, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 2466.37, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 2466.37 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 2466.37, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 2466.37 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2466.37, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 2466.37, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANTIGEN TEST", "code_information": [ { "code": "87899", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 50, "discounted_cash": 16, "minimum": 15, "maximum": 708.66, "payers_information": [ { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.18, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 16.07 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 16.07 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.93, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 23.3, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 16.07 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 16.07 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.96, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.5, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.69, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.07 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.39, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.18, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.18, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.82, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.18, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.07 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 16.07 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.53, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS - SOI : 4", "code_information": [ { "code": "2344", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5529.67, "maximum": 5529.67, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 5529.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 5529.67 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 5529.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 5529.67 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5529.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 5529.67, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ARTHROCENTESIS MAJ JOINT PERCUTA RT WSG", "code_information": [ { "code": "20610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 771.5, "discounted_cash": 323, "minimum": 109.638, "maximum": 1359.45, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 626.93, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 771.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance Off Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 771.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance On Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 771.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 771.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "case rate", "standard_charge_dollar": 771.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 285.87 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 581.69, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 468.58, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 285.87 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 285.87 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 562.3, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 452.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 633.39, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 436.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 285.87 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 329.62, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 626.93, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 626.93, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 646.32, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 355.48, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 639.86, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 626.93, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 285.87 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 285.87 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 646.32, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 614, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT CCMCC", "code_information": [ { "code": "017", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 41779, "minimum": 41779.28, "maximum": 83558.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 41779.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 81051.8, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 41779.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 41779.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 75202.7, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "case rate", "standard_charge_dollar": 60579.96, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "case rate", "standard_charge_dollar": 41779.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 72695.95, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "case rate", "standard_charge_dollar": 54313.09, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 81887.39, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "plan_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "methodology": "case rate", "standard_charge_dollar": 66846.85, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "case rate", "standard_charge_dollar": 56402.03, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "case rate", "standard_charge_dollar": 42614.89, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 81051.8, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 81051.8, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 83558.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 45957.23, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 82722.97, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Fully Insured", "methodology": "case rate", "standard_charge_dollar": 45103.9 }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Self Funded", "methodology": "case rate", "standard_charge_dollar": 48110.78 }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 81051.8, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 41779.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 65038.1 }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 41779.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 75818.61 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 41779.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 41779.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 83558.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "case rate", "standard_charge_dollar": 41779.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "case rate", "standard_charge_dollar": 79380.63, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ANTIPARIETAL CELL ANTIBODY", "code_information": [ { "code": "83516", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 81.5, "discounted_cash": 11, "minimum": 4.5, "maximum": 337.2, "payers_information": [ { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.37, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 11.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 11.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.75, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 11.53 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 11.53 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.06, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.6, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.57, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.53 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.76, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.37, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.37, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.83, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.37, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.53 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 6.6, "10th_percentile": 6.6, "90th_percentile": 44.88, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 11.53 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.91, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "APPENDIX PROCEDURES WITH MCC", "code_information": [ { "code": "397", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18625, "minimum": 18625.9, "maximum": 37251.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 18625.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 36134.32, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 18625.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 18625.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 33526.69, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "case rate", "standard_charge_dollar": 27007.61, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "case rate", "standard_charge_dollar": 18625.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 32409.14, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "case rate", "standard_charge_dollar": 24213.67, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 36506.84, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "plan_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "methodology": "case rate", "standard_charge_dollar": 29801.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "case rate", "standard_charge_dollar": 25145.02, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "case rate", "standard_charge_dollar": 18998.42, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 36134.32, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 36134.32, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 37251.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 20488.49, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 36879.36, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Fully Insured", "methodology": "case rate", "standard_charge_dollar": 19884.64 }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Self Funded", "methodology": "case rate", "standard_charge_dollar": 21210.26 }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 36134.32, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18625.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 28234.2 }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 18625.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 33425.62 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 18625.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 18625.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 37251.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "case rate", "standard_charge_dollar": 18625.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "case rate", "standard_charge_dollar": 35389.29, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ARTHROCENTESIS MEDIUM JOINT PERCUTA LT", "code_information": [ { "code": "20605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 651, "discounted_cash": 323, "minimum": 194.1, "maximum": 1359.45, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 626.93, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 651 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance Off Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 651 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance On Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 651 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 651 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "case rate", "standard_charge_dollar": 651 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 285.87 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 581.69, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 468.58, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 285.87 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 285.87 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 562.3, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 452.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 633.39, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 436.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 285.87 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 329.62, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 626.93, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 626.93, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 646.32, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 355.48, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 639.86, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 626.93, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 285.87 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 285.87 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 646.32, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 614, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "Av fistula revision open", "code_information": [ { "code": "36832", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11125.47, "discounted_cash": 5858, "minimum": 2273.622, "maximum": 11125.47, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5858.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11125.47, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 5142 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance Off Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 4471 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance On Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 3756 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 4471 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "case rate", "standard_charge_dollar": 4886 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 5858.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 2273.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5858.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10545.17, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 8494.72, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 2273.62 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 2273.62 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5858.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10193.67, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8201.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11125.47, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7908.88, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 2273.62 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5975.6, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11125.47, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11125.47, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11125.47, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6444.27, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11125.47, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11125.47, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2273.62 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5858.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5858.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5858.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 2273.62 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5858.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5858.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11125.47, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5858.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11125.47, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "AP OF SKIN GRAFT FACE FIRST 25SQ CM", "code_information": [ { "code": "15275", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3580.62, "discounted_cash": 778, "minimum": 648.18, "maximum": 3580.62, "payers_information": [ { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1540.66, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1509.53, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 648.18 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 778.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 778.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 778.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 648.18 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 778.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 778.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1556.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 778.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1478.41, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 778.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1509.53, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 3580.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance Off Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 3311 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance On Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 2781 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 3311 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "case rate", "standard_charge_dollar": 3580.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 778.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 648.18 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 778.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1400.6, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 1128.26, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 648.18 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 648.18 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 778.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1353.91, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1089.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1525.1, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1050.45, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 648.18 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 793.67, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1509.53, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1509.53, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1556.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 855.92, "additional_payer_notes": "110.00% of Medicare Rates" } ] } ] }, { "description": "ARTHROCENTESIS WUS GUIDANCE - 20606 - 16020606", "code_information": [ { "code": "20606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2135.87, "discounted_cash": 743, "minimum": 640.761, "maximum": 2135.87, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 743.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1441.73, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 2135.87 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance Off Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 2094 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance On Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 1759 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 2094 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "case rate", "standard_charge_dollar": 2135.87 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 743.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 648.18 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 743.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1337.69, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 1077.58, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 648.18 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 648.18 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 743.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1293.1, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1040.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1456.59, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1003.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 648.18 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 758.02, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1441.73, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1441.73, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1486.32, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 817.48, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1471.46, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1441.73, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 648.18 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 743.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 743.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 743.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 648.18 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 743.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 743.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1486.32, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 743.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1412, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "B CELLS TOTAL COUNT", "code_information": [ { "code": "86355", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 52, "discounted_cash": 37, "minimum": 15.6, "maximum": 52, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 37.73 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 37.73 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 52, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 37.73 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 37.73 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 50.94, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.73 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.48, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.5, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.73 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 37.73 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "AP OF SKIN GRAFT GREATER THAN 100SQ CM", "code_information": [ { "code": "15277", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4782, "discounted_cash": 2172, "minimum": 1283.568, "maximum": 4782, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2172.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4214.2, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 3807 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance Off Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 3311 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance On Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 2781 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 3311 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "case rate", "standard_charge_dollar": 3617 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 2172.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 1283.57 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2172.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3910.09, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 3149.79, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 1283.57 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 1283.57 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2172.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3779.75, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3041.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4257.65, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2932.56, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 1283.57 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2215.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4214.2, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4214.2, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4344.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2389.5, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4301.09, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4214.2, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1283.57 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2172.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2172.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2172.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 1283.57 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2172.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2172.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4344.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2172.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4127.31, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "APPL OF LOW COST SKIN SUB UP TO 100SQ CM", "code_information": [ { "code": "C5275", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2570.86, "discounted_cash": 630, "minimum": 630.79, "maximum": 2570.86, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 630.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1223.73, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 2406 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance Off Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 2094 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance On Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 1759 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 2094 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "case rate", "standard_charge_dollar": 2287 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 630.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 630.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1135.42, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 914.65, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 630.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1097.57, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 883.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1236.35, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 851.57, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 643.41, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1223.73, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1223.73, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1261.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 693.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1248.96, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1223.73, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 630.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 630.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 630.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 630.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 630.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1261.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 630.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1198.5, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ARTHROGRAM HIP RT", "code_information": [ { "code": "73525", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1758.55, "discounted_cash": 367, "minimum": 204.477, "maximum": 1758.55, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 367.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 712.56, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 367.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 204.48 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 367.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 661.14, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 532.59, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 204.48 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 204.48 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 367.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 639.1, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 514.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 719.91, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 495.86, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 204.48 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 374.65, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 712.56, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Pathfinder Advisor", "plan_name": "Path Finder Advisor Commercial (OP Only) (05-01-2021 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 552.18 }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 712.56, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 734.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 404.03, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 727.25, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 712.56, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 204.48 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 367.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 367.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 367.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 204.48 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 367.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 367.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 734.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 367.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 697.87, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BACITRACIN 100K UNITS N.S.IRRIG: 1L", "drug_information": { "unit": 1000, "type": "ML" }, "code_information": [ { "code": "63323032930", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 46.2, "10th_percentile": 46.2, "90th_percentile": 46.2, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 5.16, "10th_percentile": 5.16, "90th_percentile": 5.16, "count": "1 through 10" } ] } ] }, { "description": "Appendectomy", "code_information": [ { "code": "44950", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4903.5, "discounted_cash": 6815, "minimum": 1471.05, "maximum": 4903.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4903.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4903.5, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 4887 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance Off Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 4251 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance On Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 3571 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 4251 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "case rate", "standard_charge_dollar": 4646 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 4903.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 3121.64 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4903.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4903.5, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 4903.5, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 3121.64 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 3121.64 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4903.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4903.5, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4903.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4903.5, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4903.5, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 3121.64 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4903.5, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4903.5, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4903.5, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4903.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4903.5, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4903.5, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4903.5, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3121.64 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4903.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4903.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 4903.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 3121.64 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4903.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4903.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4903.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4903.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4903.5, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "APPL OF LOW COST SKIN SUB UP TO 100SQCM", "code_information": [ { "code": "C5277", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2541, "discounted_cash": 630, "minimum": 630.79, "maximum": 2541, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 630.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1223.73, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 2406 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance Off Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 2094 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance On Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 1759 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 2094 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "case rate", "standard_charge_dollar": 2287 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 630.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 630.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1135.42, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 914.65, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 630.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1097.57, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 883.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1236.35, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 851.57, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 643.41, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1223.73, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1223.73, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1261.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 693.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1248.96, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1223.73, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 630.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 630.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 630.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 630.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 630.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1261.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 630.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1198.5, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ARTHROGRAM KNEE RT", "code_information": [ { "code": "73580", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 701, "discounted_cash": 367, "minimum": 210.3, "maximum": 701, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 367.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 701, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 367.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 268.24 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 367.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 661.14, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 532.59, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 268.24 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 268.24 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 367.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 639.1, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 514.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 701, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 495.86, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 268.24 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 374.65, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 701, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Pathfinder Advisor", "plan_name": "Path Finder Advisor Commercial (OP Only) (05-01-2021 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 552.18 }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 701, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 701, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 404.03, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 701, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 701, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 268.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 367.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 367.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 367.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 268.24 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 367.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 367.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 701, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 367.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 697.87, "additional_payer_notes": "190.00% 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": 15617, "minimum": 14400, "maximum": 31234.48, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 27916.79 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15617.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 15617.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 31234.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "case rate", "standard_charge_dollar": 15617.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "case rate", "standard_charge_dollar": 29672.76, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15617.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 30297.45, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 15617.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 15617.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28111.03, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "case rate", "standard_charge_dollar": 22645, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "case rate", "standard_charge_dollar": 15617.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 27174, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "case rate", "standard_charge_dollar": 20302.36, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 30609.79, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "plan_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "methodology": "case rate", "standard_charge_dollar": 24987.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "case rate", "standard_charge_dollar": 21083.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "case rate", "standard_charge_dollar": 15929.54, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 30297.45, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 30297.45, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 31234.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 17178.92, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 30922.14, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Fully Insured", "methodology": "case rate", "standard_charge_dollar": 16607.48 }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Self Funded", "methodology": "case rate", "standard_charge_dollar": 17714.63 }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 30297.45, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15617.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21633.1 }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 15617.24, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS - SOI : 4", "code_information": [ { "code": "2334", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10889.72, "maximum": 10889.72, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 10889.72, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 10889.72 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 10889.72, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 10889.72 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 10889.72, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 10889.72, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "APPLICATION LONG LEG SPLINT (THIGH-ANKLE", "code_information": [ { "code": "29505", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 847.71, "discounted_cash": 171, "minimum": 171.08, "maximum": 847.71, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 171.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 331.9, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 847.71 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance Off Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 847.71 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance On Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 847.71 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 847.71 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "case rate", "standard_charge_dollar": 847.71 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 171.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 381.15 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 171.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 307.94, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 248.07, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 381.15 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 381.15 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 171.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 297.68, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 239.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 335.32, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 230.96, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 381.15 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 174.5, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 331.9, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 331.9, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 342.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.19, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 338.74, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 331.9, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 381.15 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 171.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 171.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 171.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 372.99, "10th_percentile": 372.99, "90th_percentile": 1048.23, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 381.15 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 171.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 171.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 342.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 171.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 325.05, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ARTHROGRAM SHOULDER LT", "code_information": [ { "code": "73040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1758.55, "discounted_cash": 367, "minimum": 213.174, "maximum": 1758.55, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 367.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 712.56, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 367.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 213.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 367.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 661.14, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 532.59, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 213.17 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 213.17 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 367.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 639.1, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 514.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 719.91, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 495.86, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 213.17 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 374.65, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 712.56, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Pathfinder Advisor", "plan_name": "Path Finder Advisor Commercial (OP Only) (05-01-2021 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 552.18 }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 712.56, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 734.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 404.03, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 727.25, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 712.56, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 213.17 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 367.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 367.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 367.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 213.17 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 367.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 367.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 734.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 367.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 697.87, "additional_payer_notes": "190.00% 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": 28858, "minimum": 24300, "maximum": 57717.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 28858.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 55985.92, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 28858.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 28858.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 51945.7, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "case rate", "standard_charge_dollar": 41845.14, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "case rate", "standard_charge_dollar": 28858.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 50214.17, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "case rate", "standard_charge_dollar": 37516.31, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 56563.09, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "plan_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "methodology": "case rate", "standard_charge_dollar": 46173.95, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "case rate", "standard_charge_dollar": 38959.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "case rate", "standard_charge_dollar": 29435.87, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 55985.92, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 55985.92, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 57717.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 31744.57, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 57140.27, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Fully Insured", "methodology": "case rate", "standard_charge_dollar": 31030.47 }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Self Funded", "methodology": "case rate", "standard_charge_dollar": 33099.14 }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 55985.92, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 28858.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 31989 }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 28858.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 52161.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 28858.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 28858.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 57717.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "case rate", "standard_charge_dollar": 28858.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "case rate", "standard_charge_dollar": 54831.57, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS - SOI : 1", "code_information": [ { "code": "2341", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3124.19, "maximum": 3124.19, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 3124.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 3124.19 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 3124.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 3124.19 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3124.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 3124.19, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "APPLICATION OF LOW COST SKIN SUB 25SQ CM", "code_information": [ { "code": "C5271", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2250.86, "discounted_cash": 630, "minimum": 630.79, "maximum": 2250.86, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 630.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1223.73, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 2250.86 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance Off Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 2094 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance On Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 1759 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 2094 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "case rate", "standard_charge_dollar": 2250.86 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 630.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 630.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1135.42, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 914.65, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 630.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1097.57, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 883.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1236.35, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 851.57, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 643.41, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1223.73, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1223.73, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1261.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 693.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1248.96, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1223.73, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 630.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 630.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 630.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 630.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 630.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1261.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 630.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1198.5, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BACTERIAL VAGINOSIS, NAA", "code_information": [ { "code": "87800", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 255, "discounted_cash": 43, "minimum": 43.67, "maximum": 255, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 84.72, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 43.67 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 43.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 43.67 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 78.61, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 63.32, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 43.67 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 43.67 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 75.99, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 61.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 85.59, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 58.95, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 43.67 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.54, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 84.72, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 84.72, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 87.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 48.04, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 86.47, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 84.72, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 43.67 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 43.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 43.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 43.67 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 87.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 82.97, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "APPENDIX PROCEDURES WITH CC", "code_information": [ { "code": "398", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11908, "minimum": 11908, "maximum": 25388, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11908, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23101.54, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 11908.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 11908, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21434.42, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "case rate", "standard_charge_dollar": 17266.61, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "case rate", "standard_charge_dollar": 11908, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20719.94, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "case rate", "standard_charge_dollar": 15480.4, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23339.7, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "plan_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "methodology": "case rate", "standard_charge_dollar": 19052.82, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "case rate", "standard_charge_dollar": 16075.81, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "case rate", "standard_charge_dollar": 12146.16, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23101.54, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23101.54, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23816.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13098.8, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23577.86, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Fully Insured", "methodology": "case rate", "standard_charge_dollar": 12567.28 }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Self Funded", "methodology": "case rate", "standard_charge_dollar": 13405.09 }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23101.54, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11908.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 25388 }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 11908.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 21125.32 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11908, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 11908, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23816.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "case rate", "standard_charge_dollar": 11908, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "case rate", "standard_charge_dollar": 22625.22, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "APPLICATOR KIT PROGEL", "code_information": [ { "code": "C1781", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 40, "median_amount": 3069.04, "10th_percentile": 3069.04, "90th_percentile": 3069.04, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 40, "median_amount": 1046.76, "10th_percentile": 1046.76, "90th_percentile": 1046.76, "count": "1 through 10" } ] } ] }, { "description": "ASPERGILLUS IGE", "code_information": [ { "code": "86005", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 82.3, "discounted_cash": 7, "minimum": 7.97, "maximum": 82.3, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.46, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 7.97 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 7.97 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.35, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 11.56, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 7.97 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 7.97 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.62, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.76, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.97 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.13, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.46, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.46, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.77, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.46, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.97 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 7.97 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.14, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ARBOVIRUS AB II", "code_information": [ { "code": "86652", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18, "discounted_cash": 13, "minimum": 5.4, "maximum": 18, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 13.19 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 13.19 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 13.19 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 13.19 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.81, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.19 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.45, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.51, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.19 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 13.19 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ASSAY OF AMPHETAMINE, UR", "code_information": [ { "code": "80324", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 63.7, "minimum": 7.2, "maximum": 159.33, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 15.16 } ] } ] }, { "description": "ARBOVIRUS AB I", "code_information": [ { "code": "86651", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18, "discounted_cash": 13, "minimum": 5.4, "maximum": 18, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 13.19 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 13.19 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 13.19 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 13.19 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.81, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.19 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.45, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.51, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.19 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 13.19 } ] } ] }, { "description": "ARS FOR NEEDLE DECOMPRESSION", "code_information": [ { "code": "A4215", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 15.31, "10th_percentile": 4.4, "90th_percentile": 21.65, "count": "1 through 10" } ] } ] }, { "description": "ASTHMA - SOI : 3", "code_information": [ { "code": "1413", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3236.54, "maximum": 3236.54, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 3236.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 3236.54 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 3236.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 3236.54 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3236.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 3236.54, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ARBOVIRUS AB III", "code_information": [ { "code": "86653", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18, "discounted_cash": 13, "minimum": 5.4, "maximum": 18, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 13.19 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 13.19 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 13.19 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 13.19 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.81, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.19 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.45, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.51, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.19 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 13.19 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ATHEROSCLEROSIS WITHOUT MCC", "code_information": [ { "code": "303", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5501, "minimum": 5057.6, "maximum": 11003.72, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5501.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10673.61, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 5501.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 5501.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9903.35, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "case rate", "standard_charge_dollar": 7977.7, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "case rate", "standard_charge_dollar": 5501.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9573.24, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "case rate", "standard_charge_dollar": 7152.42, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10783.65, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "plan_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "methodology": "case rate", "standard_charge_dollar": 8802.98, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "case rate", "standard_charge_dollar": 7427.51, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "case rate", "standard_charge_dollar": 5611.9, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10673.61, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10673.61, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11003.72, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6052.05, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10893.68, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Fully Insured", "methodology": "case rate", "standard_charge_dollar": 5589.52 }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Self Funded", "methodology": "case rate", "standard_charge_dollar": 5962.15 }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10673.61, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5501.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5057.6 }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 5501.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 9395.85 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5501.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 5501.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11003.72, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "case rate", "standard_charge_dollar": 5501.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "case rate", "standard_charge_dollar": 10453.53, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ARTERIAL BLOOD GASES", "code_information": [ { "code": "82803", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 130, "discounted_cash": 26, "minimum": 26.07, "maximum": 130, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 50.58, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 26.07 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 26.07 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 46.93, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 37.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 26.07 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 26.07 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 45.36, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 51.1, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 35.19, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.07 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.59, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 50.58, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 50.58, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 51.62, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 50.58, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.07 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 57.2, "10th_percentile": 57.2, "90th_percentile": 57.2, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 26.07 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 49.53, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ARTERIAL MONITORING", "code_information": [ { "code": "36620", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6370.41, "minimum": 381.147, "maximum": 6370.41, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 381.15 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 381.15 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 381.15 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 381.15 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 381.15 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 381.15 } ] } ] }, { "description": "ARTERIOGRAM EXT UNILAT", "code_information": [ { "code": "75710", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6259.89, "discounted_cash": 3324, "minimum": 327.171, "maximum": 6259.89, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3324.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6259.89, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 3324.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 327.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3324.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5983.69, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 4820.19, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 327.17 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 327.17 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3324.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5784.23, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4653.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6259.89, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4487.76, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 327.17 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3390.76, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6259.89, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Pathfinder Advisor", "plan_name": "Path Finder Advisor Commercial (OP Only) (05-01-2021 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4292.49 }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6259.89, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6259.89, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3656.7, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6259.89, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6259.89, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 327.17 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3324.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3324.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3324.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 327.17 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3324.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3324.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6259.89, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3324.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6259.89, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ARTHRO SHOULDER INJECT PROCED", "code_information": [ { "code": "23350", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1720, "minimum": 285.87, "maximum": 1720, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 285.87 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 285.87 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 285.87 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 285.87 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 285.87 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 285.87 } ] } ] }, { "description": "ARTHROCENTESIS MAJOR JT PERCUTA BI", "code_information": [ { "code": "20610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1118.8, "discounted_cash": 323, "minimum": 109.638, "maximum": 1359.45, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 626.93, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 1118.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance Off Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 1118.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance On Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 1118.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 1118.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "case rate", "standard_charge_dollar": 1118.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 285.87 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 581.69, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 468.58, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 285.87 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 285.87 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 562.3, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 452.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 633.39, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 436.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 285.87 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 329.62, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 626.93, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 626.93, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 646.32, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 355.48, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 639.86, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 626.93, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 285.87 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 285.87 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 646.32, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 614, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ARTHROCENTESIS MAJOR JT PERCUTA LT WOUG", "code_information": [ { "code": "20610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 771.5, "discounted_cash": 323, "minimum": 109.638, "maximum": 1359.45, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 626.93, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 771.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance Off Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 771.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance On Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 771.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 771.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "case rate", "standard_charge_dollar": 771.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 285.87 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 581.69, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 468.58, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 285.87 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 285.87 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 562.3, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 452.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 633.39, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 436.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 285.87 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 329.62, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 626.93, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 626.93, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 646.32, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 355.48, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 639.86, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 626.93, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 285.87 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 285.87 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 646.32, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 614, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ARTHROCENTESIS MEDIUM JOINT PERCUTA RT", "code_information": [ { "code": "20605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 651, "discounted_cash": 323, "minimum": 194.1, "maximum": 1359.45, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 626.93, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 651 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance Off Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 651 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance On Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 651 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 651 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "case rate", "standard_charge_dollar": 651 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 285.87 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 581.69, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 468.58, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 285.87 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 285.87 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 562.3, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 452.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 633.39, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 436.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 285.87 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 329.62, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 626.93, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 626.93, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 646.32, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 355.48, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 639.86, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 626.93, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 285.87 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 285.87 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 646.32, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 614, "additional_payer_notes": "190.00% 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": 20030, "minimum": 20030.8, "maximum": 40061.64, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 20030.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 38859.79, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 20030.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 20030.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 36055.48, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "case rate", "standard_charge_dollar": 29044.69, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "case rate", "standard_charge_dollar": 20030.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 34853.63, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "case rate", "standard_charge_dollar": 26040.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 39260.41, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "plan_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "methodology": "case rate", "standard_charge_dollar": 32049.31, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "case rate", "standard_charge_dollar": 27041.61, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "case rate", "standard_charge_dollar": 20431.42, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 38859.79, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 38859.79, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 40061.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 22033.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 39661.02, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Fully Insured", "methodology": "case rate", "standard_charge_dollar": 21414.87 }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Self Funded", "methodology": "case rate", "standard_charge_dollar": 22842.5 }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 38859.79, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20030.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24725.9 }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 20030.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 35997.89 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 20030.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 20030.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 40061.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "case rate", "standard_charge_dollar": 20030.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "case rate", "standard_charge_dollar": 38058.56, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BAR TIBIAL LOCKING", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 3430.7, "10th_percentile": 777, "90th_percentile": 3658.2, "count": "1 through 10" } ] } ] }, { "description": "ARTHROGRAM KNEE LT", "code_information": [ { "code": "73580", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 701, "discounted_cash": 367, "minimum": 210.3, "maximum": 701, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 367.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 701, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 367.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 268.24 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 367.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 661.14, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 532.59, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 268.24 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 268.24 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 367.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 639.1, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 514.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 701, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 495.86, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 268.24 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 374.65, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 701, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Pathfinder Advisor", "plan_name": "Path Finder Advisor Commercial (OP Only) (05-01-2021 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 552.18 }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 701, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 701, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 404.03, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 701, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 701, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 268.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 367.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 367.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 367.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 268.24 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 367.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 367.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 701, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 367.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 697.87, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ARTHROCENTESIS WUS GUIDANCE - 20604 - 16020604", "code_information": [ { "code": "20604", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 764, "discounted_cash": 323, "minimum": 229.2, "maximum": 764, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 626.93, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 764 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance Off Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 764 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance On Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 764 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 764 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "case rate", "standard_charge_dollar": 764 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 648.18 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 581.69, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 468.58, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 648.18 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 648.18 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 562.3, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 452.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 633.39, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 436.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 648.18 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 329.62, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 626.93, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 626.93, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 646.32, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 355.48, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 639.86, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 626.93, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 648.18 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 648.18 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 646.32, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 614, "additional_payer_notes": "190.00% 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": 27197, "minimum": 27197.7, "maximum": 54395.46, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 27197.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 52763.6, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 27197.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 27197.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 48955.91, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "case rate", "standard_charge_dollar": 39436.71, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "case rate", "standard_charge_dollar": 27197.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 47324.05, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "case rate", "standard_charge_dollar": 35357.01, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 53307.55, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "plan_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "methodology": "case rate", "standard_charge_dollar": 43516.37, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "case rate", "standard_charge_dollar": 36716.94, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "case rate", "standard_charge_dollar": 27741.65, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 52763.6, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 52763.6, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 54395.46, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 29917.47, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 53851.51, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Fully Insured", "methodology": "case rate", "standard_charge_dollar": 29221.26 }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Self Funded", "methodology": "case rate", "standard_charge_dollar": 31169.32 }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 52763.6, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 27197.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 32032.7 }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 27197.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 49120.27 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 27197.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 27197.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 54395.46, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "case rate", "standard_charge_dollar": 27197.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "case rate", "standard_charge_dollar": 51675.69, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BARBITURATES CONFIRMATION URINE", "code_information": [ { "code": "80345", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 48.2, "minimum": 6, "maximum": 48.2, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 10.9 } ] } ] }, { "description": "ARTHROGRAM WRIST", "code_information": [ { "code": "73115", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 999.38, "discounted_cash": 367, "minimum": 226.707, "maximum": 999.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 367.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 712.56, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 367.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 226.71 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 367.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 661.14, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 532.59, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 226.71 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 226.71 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 367.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 639.1, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 514.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 719.91, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 495.86, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 226.71 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 374.65, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 712.56, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Pathfinder Advisor", "plan_name": "Path Finder Advisor Commercial (OP Only) (05-01-2021 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 552.18 }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 712.56, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 734.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 404.03, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 727.25, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 712.56, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 226.71 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 367.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 367.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 367.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 226.71 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 367.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 367.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 734.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 367.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 697.87, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ARTHROCENTESIS WUS GUIDANCE - 20611 - 16020611", "code_information": [ { "code": "20611", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2496, "discounted_cash": 323, "minimum": 323.16, "maximum": 2496, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 626.93, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 2406 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance Off Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 2094 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance On Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 1759 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 2094 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "case rate", "standard_charge_dollar": 2287 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 648.18 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 581.69, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 468.58, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 648.18 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 648.18 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 562.3, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 452.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 633.39, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 436.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 648.18 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 329.62, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 626.93, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 626.93, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 646.32, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 355.48, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 639.86, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 626.93, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 648.18 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 648.18 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 646.32, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 614, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BACTERIAL VAGINOSIS RAPID TEST", "code_information": [ { "code": "87905", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 43.52, "discounted_cash": 12, "minimum": 12.22, "maximum": 43.52, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.71, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 12.22, "10th_percentile": 12.22, "90th_percentile": 12.22, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 12.22 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 12.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 12.22 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 17.72, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 12.22 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 12.22 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.95, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.5, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.22 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.46, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.71, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.71, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.2, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.71, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.22 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 12.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 19.15, "10th_percentile": 19.15, "90th_percentile": 19.15, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 12.22 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.22, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BARIUM ENEMA SINGLE CONTRAST", "code_information": [ { "code": "74270", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1068.57, "discounted_cash": 184, "minimum": 184.66, "maximum": 1068.57, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 184.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 358.24, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 184.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 340.7 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 184.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 332.39, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 267.76, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 340.7 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 340.7 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 184.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 321.31, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 258.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 361.93, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 249.29, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 340.7 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.35, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 358.24, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Pathfinder Advisor", "plan_name": "Path Finder Advisor Commercial (OP Only) (05-01-2021 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 267.83 }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 358.24, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 369.32, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 203.13, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 365.63, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 358.24, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 340.7 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 184.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 184.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 184.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 340.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 184.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 184.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 369.32, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 184.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 350.85, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ARTHROSCOPY", "code_information": [ { "code": "509", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 18000, "maximum": 18928.6, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18928.6 } ] } ] }, { "description": "ARTHROGRAM ELBOW LEFT", "code_information": [ { "code": "73085", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 550, "discounted_cash": 367, "minimum": 165, "maximum": 1758.55, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 367.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 550, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 367.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 200.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 367.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 550, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 532.59, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 200.62 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 200.62 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 367.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 550, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 514.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 550, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 495.86, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 200.62 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 374.65, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 550, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Pathfinder Advisor", "plan_name": "Path Finder Advisor Commercial (OP Only) (05-01-2021 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 550 }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 550, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 550, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 404.03, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 550, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 550, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 200.62 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 367.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 367.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 367.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 200.62 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 367.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 367.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 550, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 367.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 550, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BACTERIUM NOS", "code_information": [ { "code": "86609", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 22, "discounted_cash": 12, "minimum": 6.6, "maximum": 239.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 12.88 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 12.88 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 12.88 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 12.88 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.39, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.88 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.14, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.17, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.88 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 12.88 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ARTHROGRAM ELBOW RIGHT", "code_information": [ { "code": "73085", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1758.55, "discounted_cash": 367, "minimum": 165, "maximum": 1758.55, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 367.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 712.56, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 367.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 200.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 367.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 661.14, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 532.59, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 200.62 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 200.62 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 367.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 639.1, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 514.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 719.91, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 495.86, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 200.62 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 374.65, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 712.56, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Pathfinder Advisor", "plan_name": "Path Finder Advisor Commercial (OP Only) (05-01-2021 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 552.18 }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 712.56, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 734.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 404.03, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 727.25, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 712.56, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 200.62 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 367.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 367.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 367.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 200.62 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 367.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 367.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 734.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 367.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 697.87, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BARTONELLA HEMSELAE IGGM", "code_information": [ { "code": "86611", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 219.52, "discounted_cash": 10, "minimum": 10.18, "maximum": 219.52, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.75, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 10.18 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 10.18 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.32, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 14.76, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 10.18 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 10.18 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.95, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.18 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.38, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.75, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.75, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.16, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.75, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.18 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 10.18 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.34, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ASCORBIC ACID", "code_information": [ { "code": "82180", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17, "discounted_cash": 9, "minimum": 5.1, "maximum": 17, "payers_information": [ { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 9.89 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 9.89 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 14.34, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 9.89 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 9.89 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.35, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.89 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.09, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.89 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 9.89 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ASSAY OF TRANSPORTIN", "code_information": [ { "code": "84449", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 60, "discounted_cash": 18, "minimum": 18, "maximum": 60, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.92, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 18 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 18 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.4, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 26.1, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 18 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 18 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.32, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.28, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.3, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.36, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.92, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.92, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.8, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.64, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.92, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 18 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.2, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BASIC METABOLIC PANEL", "code_information": [ { "code": "80048", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 262, "discounted_cash": 8, "minimum": 8.46, "maximum": 262, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 75, "median_amount": 196.5, "10th_percentile": 196.5, "90th_percentile": 196.5, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.41, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance Off Exchange Pathway", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 8.46, "10th_percentile": 8.46, "90th_percentile": 8.46, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 8.46, "10th_percentile": 8.46, "90th_percentile": 8.46, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 8.46 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 8.46 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.23, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 12.27, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 8.46 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 8.46 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.72, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.84, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.58, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.42, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.46 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.63, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.41, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.41, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.31, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.75, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.41, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.46 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 115.28, "10th_percentile": 115.28, "90th_percentile": 115.28, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 8.46 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ASPERGILLUS GALACTOMANNON ANTIGEN DETECT", "code_information": [ { "code": "87305", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 297.5, "discounted_cash": 11, "minimum": 11.98, "maximum": 297.5, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 11.98 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.56, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 17.37, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 11.98 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 11.98 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.85, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.48, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.17, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.98 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.22, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.24, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.24, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.18, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.72, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.24, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.98 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 11.98 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.76, "additional_payer_notes": "190.00% of Medicare Rates" }, { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.24, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 11.98 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ASTHMA - SOI : 1", "code_information": [ { "code": "1411", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 1896.26, "maximum": 1896.26, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 1896.26, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 1896.26 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 1896.26, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 1896.26 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1896.26, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 1896.26, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ASPINJ INTERMED JNTBURSA", "code_information": [ { "code": "20605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1359.45, "discounted_cash": 323, "minimum": 194.1, "maximum": 1359.45, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 626.93, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 1359.45 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance Off Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 1359.45 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance On Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 1359.45 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 1359.45 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "case rate", "standard_charge_dollar": 1359.45 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 285.87 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 581.69, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 468.58, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 285.87 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 285.87 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 562.3, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 452.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 633.39, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 436.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 285.87 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 329.62, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 626.93, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 626.93, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 646.32, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 355.48, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 639.86, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 626.93, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 285.87 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 285.87 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 646.32, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 614, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ATOVAQUONE", "code_information": [ { "code": "80375", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1525, "minimum": 18.54, "maximum": 1525, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 21.53 } ] } ] }, { "description": "BB CMV NEGATIVE PRODUCT", "code_information": [ { "code": "P9073", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18, "discounted_cash": 604, "minimum": 5.4, "maximum": 819.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ASSAY OF BLOOD PKU", "code_information": [ { "code": "84030", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10, "discounted_cash": 5, "minimum": 3, "maximum": 10, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.9, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 7.98, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.57, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.43, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.61, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.05, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BALLOON PUMP INSERTION", "code_information": [ { "code": "33967", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5057.97, "minimum": 1517.391, "maximum": 5057.97, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 4887 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance Off Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 4251 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance On Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 3571 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 4251 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "case rate", "standard_charge_dollar": 4646 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 1854.49 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 1854.49 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 1854.49 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1854.49 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1854.49 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 1854.49 } ] } ] }, { "description": "BB CROSSMATCH INCUBATION", "code_information": [ { "code": "86921", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 515.1, "discounted_cash": 179, "minimum": 24.2, "maximum": 515.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 179.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 347.98, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 24.2 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 179.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 26.03 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 179.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 322.87, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 260.09, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 26.03 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 26.03 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 179.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 312.1, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 251.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 351.57, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 242.15, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.03 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 182.96, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 347.98, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 347.98, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 358.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.31, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 355.15, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 347.98, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.03 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 179.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 179.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 179.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 226.64, "10th_percentile": 226.64, "90th_percentile": 226.64, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 26.03 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 179.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 179.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 358.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 179.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 340.8, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ASTHMA - SOI : 4", "code_information": [ { "code": "1414", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5187.89, "maximum": 5187.89, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 5187.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 5187.89 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 5187.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 5187.89 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5187.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 5187.89, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AUTOMATED LEUKOCYTE COUNT", "code_information": [ { "code": "85048", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 35, "discounted_cash": 2, "minimum": 2.54, "maximum": 35, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.93, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 2.54 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 2.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 2.54 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.57, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 3.68, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 2.54 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 2.54 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.42, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.56, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.98, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3.43, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.54 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.59, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.93, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.93, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.79, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.03, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.93, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.54 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 2.54 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.83, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BB CRYOPRECIPITATE POOLED ADDITIONAL", "code_information": [ { "code": "P9012", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 342, "discounted_cash": 71, "minimum": 13.8, "maximum": 342, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 138.9, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 71.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 128.88, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 103.82, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 124.58, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 140.34, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 96.66, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 73.03, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 138.9, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 138.9, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 143.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.76, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 141.77, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 138.9, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 71.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 71.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 143.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 136.04, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "ATHEROSCLEROSIS WITH MCC", "code_information": [ { "code": "302", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9491, "minimum": 9491.6, "maximum": 18983.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9491.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18413.7, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 9491.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 9491.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17084.88, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "case rate", "standard_charge_dollar": 13762.82, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "case rate", "standard_charge_dollar": 9491.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16515.38, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "case rate", "standard_charge_dollar": 12339.08, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18603.54, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "plan_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "methodology": "case rate", "standard_charge_dollar": 15186.56, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "case rate", "standard_charge_dollar": 12813.66, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "case rate", "standard_charge_dollar": 9681.43, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18413.7, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18413.7, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18983.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10440.76, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18793.37, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Fully Insured", "methodology": "case rate", "standard_charge_dollar": 9935.26 }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Self Funded", "methodology": "case rate", "standard_charge_dollar": 10597.6 }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18413.7, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9491.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12535.3 }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 9491.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 16700.95 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9491.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 9491.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18983.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "case rate", "standard_charge_dollar": 9491.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "case rate", "standard_charge_dollar": 18034.04, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "Av fusion direct any site", "code_information": [ { "code": "36821", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10296.96, "discounted_cash": 3324, "minimum": 1905.423, "maximum": 10296.96, "payers_information": [ { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3324.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6316.11, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3324.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6449.08, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 4887 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance Off Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 4251 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance On Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 3571 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 4251 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "case rate", "standard_charge_dollar": 4646 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 3324.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 1905.42 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3324.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5983.69, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 4820.19, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 1905.42 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 1905.42 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3324.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5784.23, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4653.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6515.57, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4487.76, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 1905.42 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3390.76, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6449.08, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6449.08, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6648.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3656.7, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6582.05, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6449.08, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1905.42 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3324.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3324.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3324.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 1905.42 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3324.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3324.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6648.54, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "BB CRYOPRECIPITATE POOLED INITIAL UNIT", "code_information": [ { "code": "P9012", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 342, "discounted_cash": 71, "minimum": 13.8, "maximum": 342, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 138.9, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 71.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 128.88, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 103.82, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 124.58, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 140.34, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 96.66, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 73.03, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 138.9, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 138.9, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 143.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.76, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 141.77, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 138.9, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 71.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 71.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 143.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 136.04, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "AV SHUNT ADDITIONAL STICK", "code_information": [ { "code": "36901", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1800, "discounted_cash": 1657, "minimum": 165, "maximum": 1800, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1657.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1800, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 1800 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance Off Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 1800 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance On Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 1800 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 1800 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "case rate", "standard_charge_dollar": 1800 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 1657.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 1800 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1657.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1800, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 1800, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 1800 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 1800 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1657.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1800, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1800, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1800, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1800, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 1800 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1690.46, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1800, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1800, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1800, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1800, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1800, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1800, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1800 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1657.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1657.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1657.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 1800 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1657.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1657.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1800, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1657.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1800, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BANDAGE CUTIMED OFF-LOADER", "code_information": [ { "code": "A6454", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 106.26, "10th_percentile": 20.06, "90th_percentile": 269.33, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 160.18, "10th_percentile": 63.29, "90th_percentile": 185, "count": "1 through 10" } ] } ] }, { "description": "BB FFP APHERESIS INITIAL UNIT", "code_information": [ { "code": "P9017", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 670, "discounted_cash": 85, "minimum": 25.125, "maximum": 670, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 165.99, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 85.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 154.01, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 124.06, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 148.87, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 119.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 167.7, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 115.51, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 87.27, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 165.99, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 165.99, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 171.12, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 94.12, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 169.41, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 165.99, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 85.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 171.12, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 162.56, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "AUTOLOGOUS BONE MARROW TRANSPLANT WITH CCMCC", "code_information": [ { "code": "016", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 45570, "minimum": 45570.8, "maximum": 91141.68, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 45570.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 88407.43, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 45570.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 45570.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 82027.51, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "case rate", "standard_charge_dollar": 66077.72, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "case rate", "standard_charge_dollar": 45570.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 79293.26, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "case rate", "standard_charge_dollar": 59242.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 89318.85, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "plan_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "methodology": "case rate", "standard_charge_dollar": 72913.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "case rate", "standard_charge_dollar": 61520.63, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "case rate", "standard_charge_dollar": 46482.22, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 88407.43, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 88407.43, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 91141.68, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 50127.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 90230.26, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Fully Insured", "methodology": "case rate", "standard_charge_dollar": 49233.77 }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Self Funded", "methodology": "case rate", "standard_charge_dollar": 52515.97 }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 88407.43, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 45570.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 48759.7 }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 45570.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 82760.82 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 45570.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 45570.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 91141.68, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "case rate", "standard_charge_dollar": 45570.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "case rate", "standard_charge_dollar": 86584.6, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "AVULSION NAIL-SIMPLE,SINGLE", "code_information": [ { "code": "11730", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 589.15, "discounted_cash": 211, "minimum": 176.745, "maximum": 589.15, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 211.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 409.79, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 589.15 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance Off Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 589.15 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance On Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 589.15 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 589.15 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "case rate", "standard_charge_dollar": 589.15 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 211.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 285.87 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 211.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 380.21, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 306.28, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 285.87 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 285.87 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 211.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 367.54, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 295.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 414.01, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 285.16, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 285.87 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 215.45, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 409.79, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 409.79, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 422.46, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 232.35, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 418.24, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 409.79, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 285.87 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 211.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 211.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 211.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 259.22, "10th_percentile": 259.22, "90th_percentile": 259.22, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 285.87 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 211.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 211.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 422.46, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 211.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 401.34, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BANDAGE TUBULAR SUPPORT MEDIGRIP SZF", "code_information": [ { "code": "A6454", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 106.26, "10th_percentile": 20.06, "90th_percentile": 269.33, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 160.18, "10th_percentile": 63.29, "90th_percentile": 185, "count": "1 through 10" } ] } ] }, { "description": "BB FFP DOUBLE UNIT INITIAL UNIT", "code_information": [ { "code": "P9017", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 119, "discounted_cash": 85, "minimum": 25.125, "maximum": 670, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 119, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 85.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 119 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 119, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 119, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 119 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 119 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 119, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 119, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 119, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 115.51, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 119 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 87.27, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 119, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 119, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 119, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 94.12, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 119, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 119, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 119 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 85.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 119 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 119, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 119, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "AZACTAM 1GM NS 50ML IVPB", "drug_information": { "unit": 1, "type": "GR" }, "code_information": [ { "code": "51479004115", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 4.73, "10th_percentile": 4.73, "90th_percentile": 4.73, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 5.16, "10th_percentile": 5.16, "90th_percentile": 5.16, "count": "1 through 10" } ] } ] }, { "description": "BARBITURATES RFX", "code_information": [ { "code": "80345", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 48, "minimum": 6, "maximum": 48.2, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 10.9 } ] } ] }, { "description": "BB IRRRADIATED PLATELETS APH ADDITIONAL", "code_information": [ { "code": "P9037", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 622, "discounted_cash": 677, "minimum": 186.6, "maximum": 2400, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 622, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 622, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 622, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 622, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 622, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 622, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 622, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 622, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 622, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 622, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 622, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 622, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 622, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 622, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 622, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 622, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 622, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 622, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 622, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 622, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 622, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 622, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 622, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 622, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 622, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 622, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BABESIA IGM CHARGE ONLY", "code_information": [ { "code": "86753", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 35.25, "discounted_cash": 12, "minimum": 10.575, "maximum": 105.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.04, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 12.39 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 12.39 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.3, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 17.97, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 12.39 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 12.39 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.56, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.28, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.73, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.39 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.64, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.04, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.04, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.78, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.53, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.04, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.39 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 12.39 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.78, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.54, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BARBITURATES URINE SCREEN", "code_information": [ { "code": "80306", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 159.33, "discounted_cash": 17, "minimum": 7.2, "maximum": 159.33, "payers_information": [ { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.57, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.25, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 17.14 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 17.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 17.14 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.85, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 24.85, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 17.14 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 17.14 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.82, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.59, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.14, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.14 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.48, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.25, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.25, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.28, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.85, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.25, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.14 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 17.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 17.14 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.28, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.14, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BB IRRRADIATED PLATELETS APH INITIAL UNI", "code_information": [ { "code": "P9037", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2400, "discounted_cash": 677, "minimum": 186.6, "maximum": 2400, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 677.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1313.92, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 677.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 677.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1219.1, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 982.06, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 677.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1178.47, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 948.19, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1327.47, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 914.33, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 690.83, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1313.92, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1313.92, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1354.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 745.01, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1341.01, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1313.92, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 677.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 677.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 677.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 677.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 677.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1354.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 677.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1286.83, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "AZITHROMYCIN INJ SDV 500MG", "drug_information": { "unit": 500, "type": "ME" }, "code_information": [ { "code": "70860010041", "type": "NDC" }, { "code": "J0456", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 13.2, "10th_percentile": 13.2, "90th_percentile": 13.2, "count": "1 through 10" } ] } ] }, { "description": "BABESIA MICROTI CHARGE ONLY", "code_information": [ { "code": "87468", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 105.27, "discounted_cash": 35, "minimum": 31.581, "maximum": 105.27, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 68.07, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 63.16, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 50.88, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 61.06, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 68.78, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 47.37, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.79, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 68.07, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 68.07, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 70.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 69.48, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 68.07, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 70.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 66.67, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BARTONELLA IGG CHARGE ONLY", "code_information": [ { "code": "86611", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 219.52, "discounted_cash": 10, "minimum": 10.18, "maximum": 219.52, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.75, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 10.18 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 10.18 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.32, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 14.76, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 10.18 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 10.18 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.95, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.18 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.38, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.75, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.75, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.16, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.75, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.18 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 10.18 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.34, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BB LEUKOCYTE POOR BLOOD INITIAL UNIT", "code_information": [ { "code": "P9016", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 921.7, "discounted_cash": 184, "minimum": 184, "maximum": 921.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 184, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 356.96, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 184, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 184, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 331.2, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 266.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 184, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 320.16, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 257.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 360.64, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 248.4, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.68, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 356.96, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 356.96, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 368, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 202.4, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 364.32, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 356.96, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 184, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 184, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 184, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 405.55, "10th_percentile": 405.55, "90th_percentile": 405.55, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 184, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 184, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 368, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 184, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 349.6, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "AZTREONAM (AZACTAM) FROZEN IV BAG: 1GM", "drug_information": { "unit": 1, "type": "GR" }, "code_information": [ { "code": "51479004801", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 4.73, "10th_percentile": 4.73, "90th_percentile": 4.73, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 5.16, "10th_percentile": 5.16, "90th_percentile": 5.16, "count": "1 through 10" } ] } ] }, { "description": "BB RH", "code_information": [ { "code": "86901", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 152.55, "discounted_cash": 39, "minimum": 2.99, "maximum": 152.55, "payers_information": [ { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 76.28, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 78.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.25, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 77.85, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 76.28, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.99 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 39.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 39.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 67.12, "10th_percentile": 67.12, "90th_percentile": 67.12, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 2.99 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 78.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 74.71, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 76.28, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 2.99 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 39.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 2.99 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 70.78, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 57.01, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 2.99 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 2.99 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 68.42, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 55.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 77.07, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 53.08, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.99 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.11, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 76.28, "additional_payer_notes": "194.00% of Medicare Rates" } ] } ] }, { "description": "B BURGDORFERI IGG ANTIBODY", "code_information": [ { "code": "86618", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 75, "discounted_cash": 17, "minimum": 17.03, "maximum": 155, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.04, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 17.03 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 17.03 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.65, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 24.69, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 17.03 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 17.03 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.63, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.84, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.38, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.99, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.03 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.37, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.04, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.04, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.73, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.72, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.04, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.03 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 44, "10th_percentile": 44, "90th_percentile": 44, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 17.03 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.36, "additional_payer_notes": "190.00% 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": 11757, "minimum": 9000, "maximum": 23515.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11757.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22810.23, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 11757.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 11757.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21164.13, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "case rate", "standard_charge_dollar": 17048.88, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "case rate", "standard_charge_dollar": 11757.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20458.66, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "case rate", "standard_charge_dollar": 15285.27, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23045.39, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "plan_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "methodology": "case rate", "standard_charge_dollar": 18812.56, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "case rate", "standard_charge_dollar": 15873.1, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "case rate", "standard_charge_dollar": 11993.06, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22810.23, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22810.23, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23515.7, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12933.69, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23280.54, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Fully Insured", "methodology": "case rate", "standard_charge_dollar": 12403.72 }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Self Funded", "methodology": "case rate", "standard_charge_dollar": 13230.62 }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22810.23, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11757.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16948.3 }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 11757.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 20850.36 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11757.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 11757.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23515.7, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "case rate", "standard_charge_dollar": 11757.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "case rate", "standard_charge_dollar": 22339.92, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BASEPLATE TIBIAL ONLAY 3 LMRL", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 3430.7, "10th_percentile": 777, "90th_percentile": 3658.2, "count": "1 through 10" } ] } ] }, { "description": "BBR ABO GROUP", "code_information": [ { "code": "86900", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 83.91, "discounted_cash": 140, "minimum": 2.99, "maximum": 85, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 83.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 83.91, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 2.99 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 83.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 2.99 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 83.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 83.91, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 83.91, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 2.99 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 2.99 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 83.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 83.91, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 83.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 83.91, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 83.91, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.99 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 83.91, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 83.91, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 83.91, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 83.91, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 83.91, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 83.91, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 83.91, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.99 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 83.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 83.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 83.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 37.4, "10th_percentile": 37.4, "90th_percentile": 74.8, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 2.99 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 83.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 83.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 83.91, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 83.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 83.91, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "B BURGDORFERI LINE BLOT IGG", "code_information": [ { "code": "86617", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 177, "discounted_cash": 15, "minimum": 15.49, "maximum": 206.05, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.05, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 137.47, "10th_percentile": 137.47, "90th_percentile": 137.47, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 15.49 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 15.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 15.49 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.88, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 22.46, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 15.49 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 15.49 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.95, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.36, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.91, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.49 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.8, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.05, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.05, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.98, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.04, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.67, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.05, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.49 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 15.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 86.41, "10th_percentile": 86.41, "90th_percentile": 86.41, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 15.49 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.98, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.43, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BBR COMPATIBILTY SCREEN", "code_information": [ { "code": "86922", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 160, "discounted_cash": 179, "minimum": 24.2, "maximum": 160, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 160, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 24.2 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 160, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 26.03 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 160, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 160, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 26.03 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 26.03 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 160, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 160, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 160, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.03 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 160, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 160, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 160, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 160, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 160, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.03 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 160, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 160, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 26.03 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 160, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 160, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "B-12", "code_information": [ { "code": "82607", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 192.63, "discounted_cash": 15, "minimum": 15.08, "maximum": 192.63, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 75, "median_amount": 144.47, "10th_percentile": 144.47, "90th_percentile": 144.47, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.26, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance Off Exchange Pathway", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 15.08, "10th_percentile": 15.08, "90th_percentile": 15.08, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 15.08, "10th_percentile": 7.13, "90th_percentile": 16, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 15.08 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 15.08 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.14, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 21.87, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 15.08 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 15.08 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.24, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.56, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.36, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.08 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.38, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.26, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.26, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.86, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.26, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.08 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 84.76, "10th_percentile": 84.76, "90th_percentile": 84.76, "count": "12" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 15.08 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.65, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BBR DAT - 86880 - 5400408", "code_information": [ { "code": "86880", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 60, "discounted_cash": 62, "minimum": 5.39, "maximum": 279.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 60, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 5.39 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 60, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 5.39 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 60, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 60, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 5.39 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 5.39 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 60, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 60, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 60, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.39 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 60, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 60, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 60, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 60, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 60, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.39 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 60, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 60, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 5.39 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 60, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 60, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BABESIA IGG CHARGE ONLY", "code_information": [ { "code": "86753", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 35.25, "discounted_cash": 12, "minimum": 10.575, "maximum": 105.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.04, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 12.39 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 12.39 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.3, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 17.97, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 12.39 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 12.39 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.56, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.28, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.73, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.39 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.64, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.04, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.04, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.78, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.53, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.04, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.39 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 12.39 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.78, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.54, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BB BLOOD PRODUCTIRRADIATION", "code_information": [ { "code": "86945", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16, "discounted_cash": 39, "minimum": 4.8, "maximum": 16, "payers_information": [ { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 16 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 11.9 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 16 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 16, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 16 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 16 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16, "additional_payer_notes": "194.00% of Medicare Rates" } ] } ] }, { "description": "BBR DAT - 86880 - 5414852", "code_information": [ { "code": "86880", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 83.91, "discounted_cash": 62, "minimum": 5.39, "maximum": 279.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 83.91, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 5.39 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 62.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 5.39 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 83.91, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 83.91, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 5.39 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 5.39 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 83.91, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 83.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 83.91, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 83.84, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.39 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 63.34, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 83.91, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 83.91, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 83.91, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 68.31, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 83.91, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 83.91, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.39 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 62.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 62.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 5.39 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 83.91, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 83.91, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BACITRACIN (BACiiM) VIAL: 50,000 UNITS", "drug_information": { "unit": 50000, "type": "UN" }, "code_information": [ { "code": "70594002601", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 46.2, "10th_percentile": 46.2, "90th_percentile": 46.2, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 5.16, "10th_percentile": 5.16, "90th_percentile": 5.16, "count": "1 through 10" } ] } ] }, { "description": "BB FFP SINGLE UNIT INITIAL UNIT", "code_information": [ { "code": "P9017", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 457.75, "discounted_cash": 85, "minimum": 25.125, "maximum": 670, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 165.99, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 85.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 154.01, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 124.06, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 148.87, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 119.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 167.7, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 115.51, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 87.27, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 165.99, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 165.99, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 171.12, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 94.12, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 169.41, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 165.99, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 85.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 171.12, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 162.56, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BBTR BLOOD CULTURE PATIENT", "code_information": [ { "code": "87040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 90, "discounted_cash": 10, "minimum": 10.32, "maximum": 90, "payers_information": [ { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.02, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 10.32 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 10.32 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.58, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 14.96, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 10.32 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 10.32 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.96, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.23, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.93, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.32 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.53, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.02, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.02, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.35, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.43, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.02, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.32 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 39.6, "10th_percentile": 39.6, "90th_percentile": 39.6, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 10.32 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BB FFP THAWING", "code_information": [ { "code": "86927", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 628.26, "discounted_cash": 179, "minimum": 9.9, "maximum": 628.26, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 179.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 347.98, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 9.9 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 179.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 65.07 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 179.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 322.87, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 260.09, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 65.07 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 65.07 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 179.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 312.1, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 251.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 351.57, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 242.15, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 65.07 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 182.96, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 347.98, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 347.98, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 358.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.31, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 355.15, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 347.98, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 65.07 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 179.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 179.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 179.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 65.07 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 179.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 179.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 358.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 179.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 340.8, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BBTR DAT POST", "code_information": [ { "code": "86880", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 279.7, "discounted_cash": 62, "minimum": 5.39, "maximum": 279.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 120.47, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 5.39 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 62.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 5.39 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 111.78, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 90.05, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 5.39 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 5.39 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 108.05, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 86.94, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 121.72, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 83.84, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.39 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 63.34, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 120.47, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 120.47, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 124.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 68.31, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 122.96, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 120.47, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.39 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 62.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 62.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 5.39 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 124.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 117.99, "additional_payer_notes": "190.00% 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": 20030, "minimum": 18907.3, "maximum": 40061.64, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 20030.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 38859.79, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 20030.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 20030.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 36055.48, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "case rate", "standard_charge_dollar": 29044.69, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "case rate", "standard_charge_dollar": 20030.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 34853.63, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "case rate", "standard_charge_dollar": 26040.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 39260.41, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "plan_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "methodology": "case rate", "standard_charge_dollar": 32049.31, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "case rate", "standard_charge_dollar": 27041.61, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "case rate", "standard_charge_dollar": 20431.42, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 38859.79, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 38859.79, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 40061.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 22033.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 39661.02, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Fully Insured", "methodology": "case rate", "standard_charge_dollar": 21414.87 }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Self Funded", "methodology": "case rate", "standard_charge_dollar": 22842.5 }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 38859.79, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20030.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18907.3 }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 20030.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 35997.89 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 20030.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 20030.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 40061.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "case rate", "standard_charge_dollar": 20030.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "case rate", "standard_charge_dollar": 38058.56, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BB LEUKOCYTE POOR BLOOD ADDITIONAL UNIT", "code_information": [ { "code": "P9016", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 921.7, "discounted_cash": 184, "minimum": 184, "maximum": 921.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 184, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 356.96, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 184, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 184, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 331.2, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 266.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 184, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 320.16, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 257.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 360.64, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 248.4, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.68, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 356.96, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 356.96, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 368, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 202.4, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 364.32, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 356.96, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 184, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 184, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 184, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 405.55, "10th_percentile": 405.55, "90th_percentile": 405.55, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 184, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 184, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 368, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 184, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 349.6, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BBTR DAT PRE", "code_information": [ { "code": "86880", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 279.7, "discounted_cash": 62, "minimum": 5.39, "maximum": 279.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 120.47, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 5.39 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 62.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 5.39 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 111.78, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 90.05, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 5.39 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 5.39 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 108.05, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 86.94, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 121.72, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 83.84, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.39 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 63.34, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 120.47, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 120.47, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 124.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 68.31, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 122.96, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 120.47, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.39 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 62.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 62.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 5.39 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 124.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 117.99, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BACTERIAL ANTIGEN", "code_information": [ { "code": "86403", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18, "discounted_cash": 11, "minimum": 5.4, "maximum": 18, "payers_information": [ { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 11.54 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 11.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 11.54 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 16.73, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 11.54 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 11.54 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.58, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.54 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.77, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.69, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.54 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 11.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 11.54 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "BB ABO GROUP", "code_information": [ { "code": "86900", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 85, "discounted_cash": 140, "minimum": 2.99, "maximum": 85, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 85, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 2.99 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 2.99 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 85, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 85, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 2.99 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 2.99 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 85, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 85, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 85, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.99 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 85, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 85, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 85, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 85, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 85, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.99 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 37.4, "10th_percentile": 37.4, "90th_percentile": 74.8, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 2.99 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 85, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 85, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BB MICROHEMATOCRITHYPOTONIC CELL", "code_information": [ { "code": "86972", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 129, "discounted_cash": 179, "minimum": 19.8, "maximum": 129, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 129, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 129, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 19.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 129, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 39.04 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 129, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 129, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 129, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 39.04 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 39.04 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 129, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 129, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 129, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 129, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 129, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.04 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 129, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 129, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 129, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 129, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 129, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 129, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 129, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.04 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 129, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 129, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 129, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 39.04 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 129, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 129, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 129, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 129, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 129, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BBTR GRAM STAIN", "code_information": [ { "code": "87205", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40, "discounted_cash": 4, "minimum": 2.4, "maximum": 40, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 75, "median_amount": 30, "10th_percentile": 30, "90th_percentile": 30, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.28, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 4.27, "10th_percentile": 4.27, "90th_percentile": 4.27, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 4.27 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 4.27 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.69, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 6.19, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 4.27 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 4.27 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.43, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.37, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.76, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.27 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.36, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.28, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.28, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.7, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.45, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.28, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.27 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 17.6, "10th_percentile": 17.6, "90th_percentile": 17.6, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 4.27 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.11, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BACTERIAL VAGINOSIS NAA APTIMA", "code_information": [ { "code": "87798", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 255, "discounted_cash": 35, "minimum": 18.3, "maximum": 1653.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 68.07, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 63.16, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 50.88, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 61.06, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 68.78, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 47.37, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.79, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 68.07, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 68.07, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 70.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 69.48, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 68.07, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 47.2, "10th_percentile": 47.2, "90th_percentile": 47.2, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 70.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 66.67, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BB CROSSMATCH IMMEDIATE SPIN", "code_information": [ { "code": "86920", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 515.1, "discounted_cash": 179, "minimum": 24.2, "maximum": 515.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 179.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 347.98, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 24.2 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 179.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 41.42 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 179.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 322.87, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 260.09, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 41.42 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 41.42 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 179.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 312.1, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 251.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 351.57, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 242.15, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.42 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 182.96, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 347.98, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 347.98, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 358.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.31, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 355.15, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 347.98, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.42 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 179.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 179.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 179.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 226.64, "10th_percentile": 226.64, "90th_percentile": 226.64, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 41.42 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 179.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 179.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 358.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 179.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 340.8, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BB PLATELET CHARGE PR", "code_information": [ { "code": "P9034", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 643.65, "discounted_cash": 307, "minimum": 190.095, "maximum": 1835.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 307.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 596.45, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 307.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 307.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 553.41, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 445.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 307.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 534.96, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 430.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 602.6, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 415.06, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 313.6, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 596.45, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 596.45, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 614.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 338.2, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 608.75, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 596.45, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 307.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 307.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 307.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 307.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 307.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 614.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 307.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 584.16, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BALL AFFIXUS HUM NOSE GW ST", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 3430.7, "10th_percentile": 777, "90th_percentile": 3658.2, "count": "1 through 10" } ] } ] }, { "description": "BB CRYOPRECIPITATE ADDITIONAL UNIT", "code_information": [ { "code": "P9012", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 89.46, "discounted_cash": 71, "minimum": 13.8, "maximum": 342, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 89.46, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 71.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 89.46 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 89.46, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 89.46, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 89.46 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 89.46 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 89.46, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 89.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 89.46, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 89.46, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 89.46 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 73.03, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 89.46, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 89.46, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 89.46, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.76, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 89.46, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 89.46, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 89.46 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 71.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 71.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 89.46 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 89.46, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 89.46, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BB PREWARM TECHNIQUE", "code_information": [ { "code": "86940", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 66.1, "discounted_cash": 8, "minimum": 8.77, "maximum": 66.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.01, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 8.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 8.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 8.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.79, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 12.72, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 8.77 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 8.77 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.26, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.19, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.84, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.77 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.95, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.01, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.01, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.36, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.01, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.77 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 8.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 8.77 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.66, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BEEF ALLERGEN", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 22, "discounted_cash": 5, "minimum": 2.1, "maximum": 293.4, "payers_information": [ { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.13, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.4, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 7.57, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.08, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.23, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.13, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.13, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.34, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.13, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 9.68, "10th_percentile": 9.68, "90th_percentile": 11.88, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.92, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BB DAT", "code_information": [ { "code": "86880", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 279.7, "discounted_cash": 62, "minimum": 5.39, "maximum": 279.7, "payers_information": [ { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 111.78, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 90.05, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 5.39 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 5.39 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 108.05, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 86.94, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 121.72, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 83.84, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.39 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 63.34, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 120.47, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 120.47, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 124.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 68.31, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 122.96, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 120.47, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.39 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 62.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 62.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 5.39 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 124.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 117.99, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 120.47, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 5.39 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 62.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 5.39 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.1, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BB WHOLE BLOOD PROC", "code_information": [ { "code": "P9010", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 330, "discounted_cash": 188, "minimum": 99, "maximum": 330, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 330, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 188.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 330, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 273.92, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 328.7, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 264.47, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 330, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 255.03, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 192.69, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 330, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 330, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 330, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.8, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 330, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 330, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 188.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 188.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 330, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 330, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BB HEMOGLOBIN FETAL", "code_information": [ { "code": "85460", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6, "discounted_cash": 7, "minimum": 1.8, "maximum": 6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 6 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 6 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 6, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 6 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 6 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BBR AB PAT AHG", "code_information": [ { "code": "86905", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 42, "discounted_cash": 377, "minimum": 3.83, "maximum": 515.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 42, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 3.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 3.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 42, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 42, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 3.83 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 3.83 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 42, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 42, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 42, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.83 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 42, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 42, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 42, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 42, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 42, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.83 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 3.83 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 42, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 42, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BENZODIAZEPINE SCREEN SERUM", "code_information": [ { "code": "80346", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 69.1, "minimum": 9.6, "maximum": 100, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 16.11 } ] } ] }, { "description": "BB IRRADIATED LEUKOPOOR RBC ADDITIONAL U", "code_information": [ { "code": "P9040", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1338.15, "discounted_cash": 264, "minimum": 264.11, "maximum": 1338.15, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 528.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 264.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 501.81, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 264.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 512.37, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 264.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 264.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 475.4, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 382.96, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 264.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 459.55, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 369.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 517.66, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 356.55, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 269.39, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 512.37, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 512.37, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 528.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 290.52, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 522.94, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 512.37, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 264.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 264.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 264.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 264.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 264.11, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BBR AG DONOR", "code_information": [ { "code": "86902", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 154.53, "discounted_cash": 377, "minimum": 6.35, "maximum": 154.53, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 154.53, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 6.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 154.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 6.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 154.53, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 154.53, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 6.35 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 6.35 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 154.53, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.53, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 154.53, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 154.53, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.35 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.53, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 154.53, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 154.53, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 154.53, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.53, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 154.53, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 154.53, "additional_payer_notes": "194.00% 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": 154.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 154.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 154.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 6.35 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 154.53, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 154.53, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BB IRRADIATED LEUKOPOOR RBC INITIAL UNIT", "code_information": [ { "code": "P9040", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1338.15, "discounted_cash": 264, "minimum": 264.11, "maximum": 1338.15, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 264.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 512.37, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 264.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 264.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 475.4, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 382.96, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 264.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 459.55, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 369.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 517.66, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 356.55, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 269.39, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 512.37, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 512.37, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 528.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 290.52, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 522.94, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 512.37, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 264.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 264.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 264.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 264.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 264.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 528.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 264.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 501.81, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BBR ANTIBODY SCREEN 3 CELL SALINE", "code_information": [ { "code": "86850", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 162, "discounted_cash": 54, "minimum": 9.77, "maximum": 252.48, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 54.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 106.43, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 9.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 54.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 9.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 54.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 98.75, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 79.55, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 9.77 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 9.77 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 54.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 95.46, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 76.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 107.53, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 74.06, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.77 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 55.96, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 106.43, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 106.43, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 109.72, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60.35, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 108.62, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 106.43, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.77 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 54.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 54.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 54.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 9.77 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 54.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 54.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 109.72, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 54.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 104.23, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BILE ACIDS FRACTIONATED", "code_information": [ { "code": "82542", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 663, "discounted_cash": 24, "minimum": 8.7, "maximum": 1155.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 46.73, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 24.09 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 24.09 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.36, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 34.93, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 24.09 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 24.09 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 41.92, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.73, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 47.22, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 32.52, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.09 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.57, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 46.73, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 46.73, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 48.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.5, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 47.7, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 46.73, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.09 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 24.09 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 48.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 45.77, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BARIUM ENEMA AIR CONTRAST", "code_information": [ { "code": "74280", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1374.5, "discounted_cash": 184, "minimum": 184.66, "maximum": 1374.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 184.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 358.24, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 184.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 473.07 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 184.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 332.39, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 267.76, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 473.07 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 473.07 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 184.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 321.31, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 258.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 361.93, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 249.29, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 473.07 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.35, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 358.24, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Pathfinder Advisor", "plan_name": "Path Finder Advisor Commercial (OP Only) (05-01-2021 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 267.83 }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 358.24, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 369.32, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 203.13, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 365.63, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 358.24, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 473.07 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 184.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 184.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 184.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 473.07 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 184.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 184.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 369.32, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 184.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 350.85, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BB PACKED RED BLOOD CELLS INITIAL UNIT", "code_information": [ { "code": "P9016", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 921.7, "discounted_cash": 184, "minimum": 184, "maximum": 921.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 184, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 356.96, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 184, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 184, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 331.2, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 266.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 184, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 320.16, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 257.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 360.64, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 248.4, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.68, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 356.96, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 356.96, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 368, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 202.4, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 364.32, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 356.96, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 184, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 184, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 184, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 405.55, "10th_percentile": 405.55, "90th_percentile": 405.55, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 184, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 184, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 368, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 184, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 349.6, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BBR ATYPICAL ANTIB", "code_information": [ { "code": "86850", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 144, "discounted_cash": 54, "minimum": 9.77, "maximum": 252.48, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 54.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 106.43, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 9.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 54.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 9.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 54.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 98.75, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 79.55, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 9.77 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 9.77 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 54.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 95.46, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 76.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 107.53, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 74.06, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.77 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 55.96, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 106.43, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 106.43, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 109.72, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60.35, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 108.62, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 106.43, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.77 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 54.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 54.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 54.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 111.09, "10th_percentile": 111.09, "90th_percentile": 111.09, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 9.77 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 54.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 54.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 109.72, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 54.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 104.23, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BILIARY ENDOSCOPY WBIOPSY", "code_information": [ { "code": "47553", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6121.65, "discounted_cash": 6815, "minimum": 1836.495, "maximum": 6121.65, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6121.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6121.65, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 4887 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance Off Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 4251 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance On Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 3571 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 4251 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "case rate", "standard_charge_dollar": 4646 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 6121.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 1905.42 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6121.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6121.65, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 6121.65, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 1905.42 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 1905.42 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6121.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6121.65, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6121.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6121.65, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6121.65, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 1905.42 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6121.65, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6121.65, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6121.65, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6121.65, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6121.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6121.65, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6121.65, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1905.42 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6121.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6121.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 6121.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 1905.42 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6121.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6121.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6121.65, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6121.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6121.65, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BARTONELLA ANTIBODY PROFILE", "code_information": [ { "code": "86611", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 73.3, "discounted_cash": 10, "minimum": 10.18, "maximum": 219.52, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.75, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 10.18 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 10.18 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.32, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 14.76, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 10.18 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 10.18 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.95, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.18 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.38, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.75, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.75, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.16, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.75, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.18 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 10.18 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.34, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BB PLATELET CHARGE LVDS 7 DAY", "code_information": [ { "code": "P9034", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 633.65, "discounted_cash": 307, "minimum": 190.095, "maximum": 1835.31, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 307.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 553.41, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 445.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 307.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 534.96, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 430.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 602.6, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 415.06, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 313.6, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 596.45, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 596.45, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 614.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 338.2, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 608.75, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 596.45, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 307.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 307.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 307.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 307.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 307.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 614.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 307.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 584.16, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 307.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 596.45, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 307.45, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BBR AUTOABSORPTION II", "code_information": [ { "code": "86971", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 150, "discounted_cash": 179, "minimum": 16.2, "maximum": 154.53, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 150, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 150, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 16.2 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 150, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 150 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 150, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 150, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 150, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 150 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 150 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 150, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 150, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 150, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 150, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 150, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 150 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 150, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 150, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 150, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 150, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 150, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 150, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 150, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 150 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 150, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 150, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 150, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 150 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 150, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 150, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 150, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 150, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 150, "additional_payer_notes": "190.00% 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": 27549, "minimum": 27549.9, "maximum": 56617.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 27549.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 53446.81, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 27549.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 27549.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 49589.82, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "case rate", "standard_charge_dollar": 39947.36, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "case rate", "standard_charge_dollar": 27549.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 47936.83, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "case rate", "standard_charge_dollar": 35814.87, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 53997.8, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "plan_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "methodology": "case rate", "standard_charge_dollar": 44079.84, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "case rate", "standard_charge_dollar": 37192.37, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "case rate", "standard_charge_dollar": 28100.9, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 53446.81, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 53446.81, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 55099.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 30304.89, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 54548.8, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Fully Insured", "methodology": "case rate", "standard_charge_dollar": 29604.86 }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Self Funded", "methodology": "case rate", "standard_charge_dollar": 31578.49 }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 53446.81, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 27549.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 56617.9 }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 27549.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 49765.08 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 27549.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 27549.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 55099.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "case rate", "standard_charge_dollar": 27549.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "case rate", "standard_charge_dollar": 52344.81, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BB PLATELETS APHERESIS ADDITIONAL UNIT", "code_information": [ { "code": "P9034", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1835.31, "discounted_cash": 307, "minimum": 190.095, "maximum": 1835.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 307.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 596.45, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 307.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 307.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 553.41, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 445.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 307.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 534.96, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 430.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 602.6, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 415.06, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 313.6, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 596.45, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 596.45, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 614.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 338.2, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 608.75, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 596.45, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 307.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 307.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 307.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 307.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 307.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 614.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 307.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 584.16, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BBR DTT TREATMENT OF RBC", "code_information": [ { "code": "86970", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 70, "discounted_cash": 62, "minimum": 16.2, "maximum": 88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 16.2 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 62.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 33.84 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 33.84 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 33.84 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.84 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 63.34, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 68.31, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.84 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 62.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 62.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 33.84 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BILIRUBIN BODY FLUID", "code_information": [ { "code": "82247", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 99.5, "discounted_cash": 5, "minimum": 2.7, "maximum": 99.5, "payers_information": [ { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.74, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 5.02 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 5.02 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.04, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 7.28, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 5.02 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 5.02 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.73, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.84, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.78, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.02 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.74, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.74, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.04, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.52, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.94, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.74, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.02 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 5.02 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.04, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.54, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BB PLATELETS LEUKOCYTES REDUCED", "code_information": [ { "code": "P9031", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 60, "discounted_cash": 143, "minimum": 18, "maximum": 60, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 60, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 60, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 60, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 60, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 60, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 60, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 60, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 60, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 60, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 60, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 60, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 60, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 60, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 60, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 60, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 60, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BBR ELUATE", "code_information": [ { "code": "86860", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 130, "discounted_cash": 179, "minimum": 30.5, "maximum": 140, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 130, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 30.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 130, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 65.08 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 130, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 130, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 65.08 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 65.08 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 130, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 130, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 130, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 65.08 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 130, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 130, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 130, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 130, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 130, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 65.08 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 130, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 130, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 65.08 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 130, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 130, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BIOPSY BONE DEEP (SPINE,FEMUR)", "code_information": [ { "code": "20225", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3607, "discounted_cash": 1738, "minimum": 732.159, "maximum": 3607, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1738.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3373.35, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 3607 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance Off Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 3311 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance On Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 2781 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 3311 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "case rate", "standard_charge_dollar": 3607 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 1738.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 1728.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1738.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3129.91, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 2521.32, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 1728.79 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 1728.79 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1738.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3025.58, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2434.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3408.13, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2347.43, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 1728.79 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1773.62, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3373.35, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3373.35, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3477.68, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1912.72, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3442.9, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3373.35, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1728.79 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1738.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1738.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1738.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 1728.79 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1738.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1738.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3477.68, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1738.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3303.8, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BBR AG PAT RH PHENOTYPING", "code_information": [ { "code": "86906", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 126, "discounted_cash": 39, "minimum": 7.75, "maximum": 126, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 76.28, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 7.75 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 39.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 7.75 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 70.78, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 57.01, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 7.75 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 7.75 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 68.42, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 55.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 77.07, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 53.08, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.75 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.11, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 76.28, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 76.28, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 78.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.25, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 77.85, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 76.28, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.75 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 39.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 39.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 7.75 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 78.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 74.71, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BBR III TRIPLE ABSORPTION", "code_information": [ { "code": "86972", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 88, "discounted_cash": 179, "minimum": 19.8, "maximum": 129, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 88, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 19.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 39.04 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 88, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 88, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 39.04 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 39.04 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 88, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 88, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 88, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 88, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.04 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 88, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 88, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 88, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 88, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 88, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.04 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 39.04 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 88, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BIOPSY THYROID PERCUTANEOU", "code_information": [ { "code": "60100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 960.03, "discounted_cash": 745, "minimum": 288.009, "maximum": 960.03, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 745.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 960.03, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 960.03 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance Off Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 960.03 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance On Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 960.03 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 960.03 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "case rate", "standard_charge_dollar": 960.03 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 745.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 381.15 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 745.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 960.03, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 960.03, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 381.15 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "case rate", "standard_charge_dollar": 381.15 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 745.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 960.03, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 960.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 960.03, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 960.03, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "case rate", "standard_charge_dollar": 381.15 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 760.45, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 960.03, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 960.03, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 960.03, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 820.09, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 960.03, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 960.03, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 381.15 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 745.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 745.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 745.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "case rate", "standard_charge_dollar": 381.15 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 745.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 745.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 960.03, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 745.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 960.03, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BB ANTIBODY SCREEN", "code_information": [ { "code": "86850", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 252.48, "discounted_cash": 54, "minimum": 9.77, "maximum": 252.48, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 54.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 106.43, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 9.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 54.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 9.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 54.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 98.75, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 79.55, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 9.77 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 9.77 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 54.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 95.46, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 76.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 107.53, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 74.06, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.77 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 55.96, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 106.43, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 106.43, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 109.72, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60.35, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 108.62, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 106.43, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.77 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 54.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 54.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 54.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 111.09, "10th_percentile": 111.09, "90th_percentile": 111.09, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 9.77 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 54.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 54.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 109.72, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 54.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 104.23, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BBR AUTOABSORPTION I", "code_information": [ { "code": "86978", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 150, "discounted_cash": 62, "minimum": 19.8, "maximum": 150, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 120.47, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 19.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 62.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 26.03 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 111.78, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 90.05, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 26.03 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 26.03 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 108.05, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 86.94, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 121.72, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 83.84, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.03 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 63.34, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 120.47, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 120.47, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 124.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 68.31, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 122.96, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 120.47, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.03 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 62.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 62.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 26.03 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 124.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 117.99, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BBR MICROHEMATOCRITHYPOTONIC CELL", "code_information": [ { "code": "86972", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 85, "discounted_cash": 179, "minimum": 19.8, "maximum": 129, "payers_information": [ { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 85, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 85, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 85, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.04 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 85, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 85, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 85, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 85, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 85, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.04 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 39.04 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 85, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 85, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 85, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 19.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 39.04 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 85, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 85, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 39.04 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 39.04 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BIOSTOP G SZ 12MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 3430.7, "10th_percentile": 777, "90th_percentile": 3658.2, "count": "1 through 10" } ] } ] }, { "description": "BB AUTO OR DIRECTED DONOR", "code_information": [ { "code": "86890", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 312, "discounted_cash": 179, "minimum": 65.07, "maximum": 312, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 179.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 312, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 83.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 179.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 65.07 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 179.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 312, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 260.09, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 65.07 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 65.07 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 179.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 312, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 251.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 312, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 242.15, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 65.07 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 182.96, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 312, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 312, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 312, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.31, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 312, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 312, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 65.07 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 179.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 179.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 179.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 65.07 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 179.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 179.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 312, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 179.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 312, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BBR CHLORQUINE EGA", "code_information": [ { "code": "86860", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 140, "discounted_cash": 179, "minimum": 30.5, "maximum": 140, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 140, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 140, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 30.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 140, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 65.08 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 140, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 140, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 140, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 65.08 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 65.08 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 140, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 140, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 140, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 140, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 140, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 65.08 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 140, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 140, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 140, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 140, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 140, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 140, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 140, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 65.08 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 140, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 140, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 140, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 65.08 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 140, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 140, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 140, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 140, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 140, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BBR RH", "code_information": [ { "code": "86901", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 45.77, "discounted_cash": 39, "minimum": 2.99, "maximum": 152.55, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 45.77, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 2.99 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 39.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 2.99 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 45.77, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 45.77, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 2.99 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 2.99 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 45.77, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 45.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 45.77, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 45.77, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.99 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.11, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 45.77, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 45.77, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 45.77, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.25, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 45.77, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 45.77, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.99 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 39.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 39.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 67.12, "10th_percentile": 67.12, "90th_percentile": 67.12, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 2.99 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 45.77, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 45.77, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BIPAPCPAP INITIAL", "code_information": [ { "code": "94660", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1370, "discounted_cash": 230, "minimum": 24.843, "maximum": 1370, "payers_information": [ { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 438.01, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 447.23, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 230.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 24.84 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 414.95, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 334.27, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 24.84 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 24.84 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 401.12, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 322.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 451.84, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 311.22, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.84 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.14, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 447.23, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 447.23, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 461.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 253.58, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 456.45, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 447.23, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.84 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 230.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 230.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 24.84 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 461.06, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "BB COOMBS TEST INDIRECT QUAL", "code_information": [ { "code": "86885", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8, "discounted_cash": 179, "minimum": 2.4, "maximum": 8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 5.72 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 5.72 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 5.72 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 5.72 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.72 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.72 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 5.72 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BBR COMPATIBILITY", "code_information": [ { "code": "86880", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 160, "discounted_cash": 62, "minimum": 5.39, "maximum": 279.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 120.47, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 5.39 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 62.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 5.39 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 111.78, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 90.05, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 5.39 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 5.39 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 108.05, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 86.94, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 121.72, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 83.84, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.39 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 63.34, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 120.47, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 120.47, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 124.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 68.31, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 122.96, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 120.47, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.39 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 62.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 62.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 5.39 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 124.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 117.99, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BBTR BILIRUBIN PRE", "code_information": [ { "code": "82247", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 96, "discounted_cash": 5, "minimum": 2.7, "maximum": 99.5, "payers_information": [ { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.74, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 5.02 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 5.02 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.04, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 7.28, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 5.02 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 5.02 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.73, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.84, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.78, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.02 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.74, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.74, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.04, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.52, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.94, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.74, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.02 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 5.02 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.04, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.54, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BB CRYOPRECIPITATE INITIAL UNIT", "code_information": [ { "code": "P9012", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 46, "discounted_cash": 71, "minimum": 13.8, "maximum": 342, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 46, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 46 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 46, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 46, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 46 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 46 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 46, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 46, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 46, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 46, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 46, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 46, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 46, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 46, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 46 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 46, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 46, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BBR ENZYME TREATMENT", "code_information": [ { "code": "86971", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 154.53, "discounted_cash": 179, "minimum": 16.2, "maximum": 154.53, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 154.53, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 16.2 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 154.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 154.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 154.53, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 154.53, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 154.53 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 154.53 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 154.53, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.53, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 154.53, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 154.53, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 154.53 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.53, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 154.53, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 154.53, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 154.53, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.53, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 154.53, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 154.53, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 154.53 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 154.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 154.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 154.53 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 154.53, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 154.53, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BBTR BLOOD CULTURE UNIT", "code_information": [ { "code": "87040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 90, "discounted_cash": 10, "minimum": 10.32, "maximum": 90, "payers_information": [ { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.02, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 10.32 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 10.32 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.58, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 14.96, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 10.32 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 10.32 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.96, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.23, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.93, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.32 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.53, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.02, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.02, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.35, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.43, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.02, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.32 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 39.6, "10th_percentile": 39.6, "90th_percentile": 39.6, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 10.32 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BLOOD CULTURE 4TH SET", "code_information": [ { "code": "87040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 90, "discounted_cash": 10, "minimum": 10.32, "maximum": 90, "payers_information": [ { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.02, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 10.32 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 10.32 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.58, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 14.96, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 10.32 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 10.32 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.96, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.23, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.93, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.32 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.53, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.02, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.02, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.35, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.43, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.02, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.32 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 39.6, "10th_percentile": 39.6, "90th_percentile": 39.6, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 10.32 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BB FFP APHERESIS ADDITIONAL UNITS", "code_information": [ { "code": "P9017", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 138, "discounted_cash": 85, "minimum": 25.125, "maximum": 670, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 138, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 85.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 138 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 138, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 124.06, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 138 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 138 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 138, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 119.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 138, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 115.51, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 138 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 87.27, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 138, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 138, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 138, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 94.12, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 138, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 138, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 138 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 85.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 138 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 138, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 138, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BBR PREWARM TECHNIQUE II", "code_information": [ { "code": "86940", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 50, "discounted_cash": 8, "minimum": 8.77, "maximum": 66.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.01, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 8.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 8.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 8.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.79, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 12.72, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 8.77 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 8.77 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.26, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.19, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.84, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.77 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.95, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.01, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.01, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.36, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.01, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.77 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 8.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 8.77 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.66, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BLOOD SMEAR WO MANUAL DIFF WBC", "code_information": [ { "code": "85008", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7, "discounted_cash": 3, "minimum": 2.1, "maximum": 7, "payers_information": [ { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 3.43 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 3.43 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.97, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.72, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.63, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.43 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.5, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.65, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.65, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.77, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.79, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.65, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.43 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 3.43 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.52, "additional_payer_notes": "190.00% of Medicare Rates" }, { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.65, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 3.43 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 3.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 3.43 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.17, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 4.97, "additional_payer_notes": "145.00% of Medicare Rates" } ] } ] }, { "description": "BB FFP DOUBLE UNIT ADDITIONAL UNIT", "code_information": [ { "code": "P9017", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 119, "discounted_cash": 85, "minimum": 25.125, "maximum": 670, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 119, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 85.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 119 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 119, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 119, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 119 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 119 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 119, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 119, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 119, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 115.51, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 119 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 87.27, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 119, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 119, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 119, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 94.12, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 119, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 119, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 119 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 85.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 119 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 119, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 119, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BBR TITRATION", "code_information": [ { "code": "86886", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 65, "discounted_cash": 179, "minimum": 5.18, "maximum": 65, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 65, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 5.18 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 5.18 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 65, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 65, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 5.18 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 5.18 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 65, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 65, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 65, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.18 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 65, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 65, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 65, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 65, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 65, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.18 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 5.18 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 65, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 65, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BEHAVIORAL AND DEVELOPMENTAL DISORDERS", "code_information": [ { "code": "886", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16189, "minimum": 11917.9, "maximum": 32379.42, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16189.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 31408.04, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "case rate", "standard_charge_dollar": 16189.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 16189.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 29141.48, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "case rate", "standard_charge_dollar": 23475.08, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "case rate", "standard_charge_dollar": 16189.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28170.1, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "case rate", "standard_charge_dollar": 21046.61, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 31731.83, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "plan_name": "INDEPENDENT MEDICAL SOLUTIONS (IMS) Commercial", "methodology": "case rate", "standard_charge_dollar": 25903.54, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "case rate", "standard_charge_dollar": 21856.11, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "case rate", "standard_charge_dollar": 16513.49, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 31408.04, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 31408.04, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 32379.42, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 17808.67, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 32055.63, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Fully Insured", "methodology": "case rate", "standard_charge_dollar": 17231.03 }, { "payer_name": "Southeastern Indiana Health Operations", "plan_name": "SIHO Self Funded", "methodology": "case rate", "standard_charge_dollar": 18379.75 }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 31408.04, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16189.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11917.9 }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 16189.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 28964.96 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16189.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 16189.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 32379.42, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "case rate", "standard_charge_dollar": 16189.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "case rate", "standard_charge_dollar": 30760.45, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BLOOD TRANSFUSION UP TO 6 HRS", "code_information": [ { "code": "36430", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 402, "discounted_cash": 464, "minimum": 90, "maximum": 1940.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 402, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 402, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 402 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance Off Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 402 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance On Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 402 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 402 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "case rate", "standard_charge_dollar": 402 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 402, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 383.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 402, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 402, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 402, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 383.41 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 383.41 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 402, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 402, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 402, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 402, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 402, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 383.41 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 402, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 402, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 402, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 402, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 402, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 402, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 402, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 383.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 402, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 402, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 402, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 768.11, "10th_percentile": 768.11, "90th_percentile": 768.11, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 383.41 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 402, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 402, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 402, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 402, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 402, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BB FFP SINGLE UNIT ADDITIONAL UNIT", "code_information": [ { "code": "P9017", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 457.75, "discounted_cash": 85, "minimum": 25.125, "maximum": 670, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 165.99, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 85.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 154.01, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 124.06, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 148.87, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 119.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 167.7, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 115.51, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 87.27, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 165.99, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 165.99, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 171.12, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 94.12, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 169.41, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 165.99, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 85.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 171.12, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 162.56, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BBR TRIPLE ABSORPTIO I", "code_information": [ { "code": "86970", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 88, "discounted_cash": 62, "minimum": 16.2, "maximum": 88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 88, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 16.2 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 62.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 33.84 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 88, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 88, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 33.84 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 33.84 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 88, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 86.94, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 88, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 83.84, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.84 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 63.34, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 88, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 88, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 68.31, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 88, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 88, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.84 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 62.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 62.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 33.84 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 88, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BENCE JONES PROTEIN RANDOM URINE", "code_information": [ { "code": "86335", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 80.9, "discounted_cash": 29, "minimum": 15.3, "maximum": 80.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 56.94, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 29.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 29.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 29.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52.83, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 42.56, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 29.35 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 29.35 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 51.07, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 57.53, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 39.62, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.35 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.94, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 56.94, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 56.94, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 58.7, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.29, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 58.11, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 56.94, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.35 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 29.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 29.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 35.6, "10th_percentile": 35.6, "90th_percentile": 35.6, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 29.35 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 58.7, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 55.77, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BLOOD TRANSFUSION UP TO 8 HRS", "code_information": [ { "code": "36430", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 539, "discounted_cash": 464, "minimum": 90, "maximum": 1940.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 464.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 539, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 539 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance Off Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 539 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Insurance On Exchange Pathway", "methodology": "case rate", "standard_charge_dollar": 539 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 539 }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "case rate", "standard_charge_dollar": 539 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 464.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 383.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 464.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 539, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 539, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 383.41 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 383.41 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 464.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 539, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 539, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 539, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 539, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 383.41 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 473.76, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 539, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 539, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 539, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 510.92, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 539, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 539, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 383.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 464.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 464.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 464.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 768.11, "10th_percentile": 768.11, "90th_percentile": 768.11, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 383.41 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 464.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 464.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 539, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 464.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 539, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BB FFPCCP", "code_information": [ { "code": "P9017", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 83.75, "discounted_cash": 85, "minimum": 25.125, "maximum": 670, "payers_information": [ { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 83.75, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 83.75, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 83.75 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 83.75, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 83.75, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 83.75, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 83.75, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 83.75, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 83.75, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 83.75, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 83.75 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 83.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 83.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 83.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 83.75 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 83.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 83.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 83.75, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 83.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 83.75, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 83.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 83.75, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 83.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 83.75 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 83.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 83.75, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 83.75, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 83.75 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 83.75 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 83.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 83.75, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 83.75, "additional_payer_notes": "140.00% of Medicare Rates" } ] } ] }, { "description": "BBTR ANTIBODY SCREEN POST", "code_information": [ { "code": "86850", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 252.48, "discounted_cash": 54, "minimum": 9.77, "maximum": 252.48, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 54.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 106.43, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 9.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 54.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 9.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 54.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 98.75, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 79.55, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 9.77 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 9.77 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 54.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 95.46, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 76.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 107.53, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 74.06, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.77 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 55.96, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 106.43, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 106.43, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 109.72, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60.35, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 108.62, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 106.43, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.77 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 54.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 54.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 54.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 111.09, "10th_percentile": 111.09, "90th_percentile": 111.09, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 9.77 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 54.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 54.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 109.72, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 54.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 104.23, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BENZODIAZAPINE RFX", "code_information": [ { "code": "80347", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 48, "minimum": 14.4, "maximum": 93.2, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 23.04 } ] } ] }, { "description": "BODY FLUID - ADENOSINE DEAMINASE PL FLUI", "code_information": [ { "code": "84311", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 74.6, "discounted_cash": 8, "minimum": 3.6, "maximum": 74.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.71, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.58, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 11.75, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.09, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.88, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.94, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.26, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.71, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.71, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.91, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.04, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.71, "additional_payer_notes": "194.00% 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": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.39, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BB PACKED RED BLOOD CELLS ADDITIONAL UNI", "code_information": [ { "code": "P9016", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 921.7, "discounted_cash": 184, "minimum": 184, "maximum": 921.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 184, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 356.96, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 184, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 184, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 331.2, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 266.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 184, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 320.16, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 257.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 360.64, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 248.4, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.68, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 356.96, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 356.96, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 368, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 202.4, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 364.32, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 356.96, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 184, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 184, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 184, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 405.55, "10th_percentile": 405.55, "90th_percentile": 405.55, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 184, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 184, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 368, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 184, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 349.6, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BBTR ANTIBODY SCREEN PRE", "code_information": [ { "code": "86850", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 252.48, "discounted_cash": 54, "minimum": 9.77, "maximum": 252.48, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 54.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 106.43, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 9.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 54.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 9.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 54.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 98.75, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 79.55, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 9.77 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 9.77 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 54.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 95.46, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 76.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 107.53, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 74.06, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.77 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 55.96, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 106.43, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 106.43, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 109.72, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60.35, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 108.62, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 106.43, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.77 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 54.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 54.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 54.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 111.09, "10th_percentile": 111.09, "90th_percentile": 111.09, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 9.77 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 54.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 54.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 109.72, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 54.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 104.23, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BODY FLUID CELL COUNT WDIFF NOT BLOOD", "code_information": [ { "code": "89051", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 110, "discounted_cash": 5, "minimum": 5.6, "maximum": 340, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.86, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 5.6 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 5.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 5.6 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.08, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 8.12, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 5.6 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 5.6 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.74, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.84, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.98, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.56, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.6 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.71, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.86, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.86, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.16, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.09, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.86, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.6 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 5.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.64, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BB PHLEBOTOMY", "code_information": [ { "code": "99195", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 63, "discounted_cash": 140, "minimum": 18.9, "maximum": 63, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 63, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 63 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 63, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 63, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 63 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 63 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 63, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 63, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 63, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 63 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 63, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 63, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 63, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 63, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 63, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 63, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 63, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 63 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 63 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 63, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 63, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BENZODIAZEPINE SCREEN WITH CONFIR WB", "code_information": [ { "code": "80307", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 280.95, "discounted_cash": 62, "minimum": 4.5, "maximum": 280.95, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 75, "median_amount": 93, "10th_percentile": 93, "90th_percentile": 93, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 120.55, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 62.14, "10th_percentile": 31.7, "90th_percentile": 62.14, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 62.14 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 62.14 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 111.85, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 90.1, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 62.14 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 62.14 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 108.12, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 121.79, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 83.89, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 62.14 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 63.38, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 120.55, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 120.55, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 124.28, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 68.35, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 123.04, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 120.55, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 62.14 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 71.12, "10th_percentile": 71.12, "90th_percentile": 71.12, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 62.14 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 124.28, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 118.07, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BERMUDA GRASS IGE", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 27, "discounted_cash": 5, "minimum": 2.1, "maximum": 293.4, "payers_information": [ { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.13, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.4, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 7.57, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.08, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.23, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.13, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.13, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.34, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.13, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 11.88, "10th_percentile": 9.75, "90th_percentile": 43.03, "count": "13" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.92, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BOLT 6.5X80MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Commercial PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70, "median_amount": 3430.7, "10th_percentile": 777, "90th_percentile": 3658.2, "count": "1 through 10" } ] } ] }, { "description": "BB PLATELET CHRG LVDS 7 DAY IRR", "code_information": [ { "code": "P9034", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 687.65, "discounted_cash": 307, "minimum": 190.095, "maximum": 1835.31, "payers_information": [ { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 596.45, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 596.45, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 614.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 338.2, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 608.75, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 596.45, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 307.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 307.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 307.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 307.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 307.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 614.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 307.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 584.16, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 307.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 596.45, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 307.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 307.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 553.41, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 445.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 307.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 534.96, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 430.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 602.6, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 415.06, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 313.6, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "BETA 2 TRANSFERRIN 2", "code_information": [ { "code": "86335", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 51, "discounted_cash": 29, "minimum": 15.3, "maximum": 80.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 51, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 29.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 29.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 29.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 51, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 42.56, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 29.35 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 29.35 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 51, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 51, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 39.62, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.35 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.94, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 51, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 51, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 51, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.29, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 51, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 51, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.35 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 29.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 29.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 35.6, "10th_percentile": 35.6, "90th_percentile": 35.6, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 29.35 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 51, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 51, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BB PLATELETS APHERESIS INITIAL UNIT", "code_information": [ { "code": "P9034", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1835.31, "discounted_cash": 307, "minimum": 190.095, "maximum": 1835.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 307.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 596.45, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 307.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 307.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 553.41, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 445.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 307.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 534.96, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 430.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 602.6, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 415.06, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 313.6, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 596.45, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 596.45, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 614.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 338.2, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 608.75, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 596.45, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 307.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 307.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 307.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 307.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 307.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 614.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 307.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 584.16, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BETA LACTAMASE", "code_information": [ { "code": "87185", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9, "discounted_cash": 4, "minimum": 2.7, "maximum": 18, "payers_information": [ { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 4.75 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 4.75 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.55, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 4.75 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 4.75 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.27, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.41, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.75 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.85, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.23, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.75 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 4.75 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BERYLLIUM WHOLE BLOOD", "code_information": [ { "code": "83018", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 138, "discounted_cash": 21, "minimum": 21.96, "maximum": 190, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 42.6, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 21.96 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 21.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 21.96 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 39.53, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 31.84, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 21.96 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 21.96 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 38.21, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.04, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.65, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.96 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.4, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 42.6, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 42.6, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.16, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.48, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 42.6, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.96 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 21.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 21.96 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 41.72, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BB ROSETTE TEST", "code_information": [ { "code": "85461", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12, "discounted_cash": 9, "minimum": 3.6, "maximum": 60, "payers_information": [ { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 9.36 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 9.36 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.36 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.55, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.3, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.36 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 9.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 9.36 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 9.36 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 9.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 9.36 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 12, "additional_payer_notes": "145.00% of Medicare Rates" } ] } ] }, { "description": "BETA-2-GLYCOPROTEIN IGA", "code_information": [ { "code": "86146", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40.7, "discounted_cash": 25, "minimum": 12.21, "maximum": 40.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 40.7, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 25.45 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 25.45 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 40.7, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 36.9, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 25.45 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 25.45 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 40.7, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 40.7, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.36, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.45 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.96, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 40.7, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 40.7, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 40.7, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 40.7, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 40.7, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.45 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 17.91, "10th_percentile": 17.91, "90th_percentile": 17.91, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 25.45 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 40.7, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 40.7, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BETA HCG QUANT", "code_information": [ { "code": "84702", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 130, "discounted_cash": 15, "minimum": 3.9, "maximum": 130, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 75, "median_amount": 97.5, "10th_percentile": 97.5, "90th_percentile": 97.5, "count": "1 through 10" }, { "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": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.2, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 15.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 15.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.09, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 21.82, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 15.05 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 15.05 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.19, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.5, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.32, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.05 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.35, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.2, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.2, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.8, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.2, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.05 }, { "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 Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44, "median_amount": 57.2, "10th_percentile": 57.2, "90th_percentile": 114.4, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 15.05 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.6, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BB WASHED CELLS PREP", "code_information": [ { "code": "P9022", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 461.19, "discounted_cash": 366, "minimum": 138.357, "maximum": 461.19, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 366.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 461.19, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 366.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 366.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 461.19, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 461.19, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 366.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 461.19, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 461.19, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 461.19, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 461.19, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 374.11, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 461.19, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 461.19, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 461.19, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 403.45, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 461.19, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 461.19, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 366.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 366.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 366.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 278.73 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 366.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 366.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 461.19, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 366.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 461.19, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BETA-2-MICROGLOBULIN", "code_information": [ { "code": "82232", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40, "discounted_cash": 16, "minimum": 12, "maximum": 40, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.39, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 16.18 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 16.18 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.12, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 23.46, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 16.18 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 16.18 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.15, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.71, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.84, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.18 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.5, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.39, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.39, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.8, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.04, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.39, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.18 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 16.18 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.74, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BETA-HYDROXYBUTYRATE", "code_information": [ { "code": "82010", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 208.25, "discounted_cash": 8, "minimum": 8.17, "maximum": 208.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.85, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 8.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 8.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 8.17 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 8.17 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.22, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.01, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.03, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.17 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.33, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.85, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.85, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.99, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.85, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.17 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 8.17 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.52, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BBR AG PAT AHG", "code_information": [ { "code": "86905", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 515.1, "discounted_cash": 377, "minimum": 3.83, "maximum": 515.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 377.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 515.1, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 3.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 377.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 3.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 377.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 515.1, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 515.1, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 3.83 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 3.83 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 377.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 515.1, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 515.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 515.1, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 509.45, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.83 }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 384.92, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 515.1, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 515.1, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 515.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 415.11, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 515.1, "additional_payer_notes": "198.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 515.1, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.83 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 377.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 377.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Optum VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 377.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicaid CHIP - Hoosier Care", "methodology": "fee schedule", "standard_charge_dollar": 3.83 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 377.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 377.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 515.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Worthington Christian Fellowship", "plan_name": "Worthington Christian Fellowship Medicare", "methodology": "fee schedule", "standard_charge_dollar": 377.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zelis Healthcare FKA Stratose", "plan_name": "Zelis Healthcare FKA Stratose Wokers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 515.1, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "BILE ACIDS", "code_information": [ { "code": "82239", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 51.36, "discounted_cash": 17, "minimum": 15.408, "maximum": 51.36, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Americas Choice Provider Network ACPN", "plan_name": "Americas Choice Provider Network ACPN Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.21, "additional_payer_notes": "194.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Commercial Traditional", "methodology": "fee schedule", "standard_charge_dollar": 17.12 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 17.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 17.12 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS Workers Compensation", "plan_name": "BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.82, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Exchange - QHP", "methodology": "fee schedule", "standard_charge_dollar": 24.82, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Healthy Indiana Plan - HIP", "methodology": "fee schedule", "standard_charge_dollar": 17.12 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicaid - Hoosier Healthwise", "methodology": "fee schedule", "standard_charge_dollar": 17.12 }, { "payer_name": "Care Source", "plan_name": "Care Source Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corvel Workers Compensation", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.79, "additional_payer_notes": "174.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Surgery Plus Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.97, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Encore Health Network Workers Compensation", "plan_name": "Encore Health Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.56, "additional_payer_notes": "196.00% of Medicare Rates" }, { "payer_name": "Monroe Medical Group and Managed Health Services", "plan_name": "Monroe Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.11,